Binge eating and emotional eating - when is it a disorder, and where can you get help?

During a binge, you eat far more in a short time than most people would in similar circumstances. At the same time, you feel that you are losing control over your eating. You may eat quickly, without being hungry, until you feel uncomfortably full. After a binge, you may feel low or guilty.

Eating in response to emotions, for example after a difficult day, does not always mean binge eating. You may reach for food to comfort yourself or relieve stress and still be in control of how much you eat. Emotional eating on its own is therefore not a diagnosis of an eating disorder.

If binges keep coming back and cause you distress, it is a good idea to talk to a psychiatrist or clinical psychologist. A specialist will help you find out whether you have binge eating disorder, which is commonly called compulsive overeating. Treatment is based mainly on psychotherapy. With a therapist, you learn to recognise the situations and emotions that trigger binges, and you work on eating regularly.

In brief

• Emotional eating is a colloquial term, not a diagnosis. Binge eating disorder is diagnosed by a specialist when binges with loss of control happen regularly and cause distress. Regular vomiting, use of laxatives or starving yourself after binges raise the suspicion of bulimia.
• The first-line treatment is psychotherapy, and its best-studied form is cognitive behavioural therapy. After this treatment, binges stop in roughly half of people. Medication should not be the only treatment.
• GLP-1 obesity medicines (GLP-1 receptor agonists) reduce hunger, but they are not licensed for treating binge eating. Studies in people with binge eating have so far included only small numbers of patients.
• Obesity can be treated even if you have binges, but the doctor needs to know about them before deciding on medication. The NICE guidelines advise against trying to lose weight, for example by dieting, during psychotherapy for binge eating, because it is likely to trigger binges. However, in a study of 136 people with binge eating and obesity, a weight-loss programme run by psychologists reduced the number of binges.

How is binge eating different from emotional eating and bulimia?

Emotional eating means eating in response to emotions, without physical hunger, for example to relieve stress or to comfort yourself after a setback. In its 2024 guidelines, the Polish Society for the Treatment of Obesity (PTLO) describes it as one form of emotional hunger and notes that it is a colloquial term. Tell your doctor about emotional eating, because it can affect how your obesity treatment goes (3). Binge eating disorder is often abbreviated to BED. Like bulimia, it is an eating disorder. Both conditions involve binges with loss of control, but in bulimia the person then regularly tries to avoid gaining weight: they make themselves vomit, starve themselves, misuse laxatives or exercise very intensively.

If a patient vomits or misuses laxatives or diuretics, the doctor checks their hydration and electrolyte levels. Bulimia and anorexia nervosa, including a past history of either, are contraindications to the obesity medicine that contains naltrexone and bupropion (5).

When does binge eating become a disorder?

It is called a disorder when binges with loss of control happen regularly (usually at least once a week for at least three months), cause marked distress or make everyday life difficult, and are not regularly followed by vomiting, starving yourself or other attempts to avoid gaining weight (1, 2). The diagnosis is made by a specialist after talking to the patient.

A screening test, including one you find online, can help you decide whether to book an appointment, but it is not enough for a diagnosis. The specialist will also ask how your weight has changed and about previous diets, vomiting, exercise and how you feel about your body.

Up to 30% of people with obesity who seek weight-loss treatment have binge eating disorder (1). In a WHO study based on interviews with more than 24,000 adults from 14 countries, only 38% of people who met the criteria for BED said they had ever been treated for an eating disorder (6). The most common barriers to seeking help are shame and fear of being judged. Some people with the disorder see a doctor only to lose weight and do not know they have an eating disorder.

What exactly counts as a binge?

DSM-5 is the American manual that describes mental disorders and how to diagnose them. According to DSM-5, a binge is an episode in which a person eats, within a set period of time, for example within two hours, an amount of food that is clearly larger than most people would eat in that time, and feels a loss of control while doing so. A binge comes with at least three of five features (1):

• Eating much faster than usual
• Eating until uncomfortably full
• Eating large amounts without feeling hungry
• Eating alone out of embarrassment at how much you are eating
• Feeling low, disgusted with yourself or guilty after the binge

The number of binges per week determines how severe the disorder is: from mild (1-3 binges) to extreme (14 or more) (1). The WHO International Classification of Diseases (ICD-11) describes a binge more broadly. What counts is a subjective sense of loss of control and eating clearly more than usual or differently from usual, not exactly how much the person ate (2).

Which conditions often go with binge eating?

In the interview-based WHO study, 79% of people with binge eating disorder had also had another mental disorder at some point in their lives (6). Most often these are mood disorders such as depression. Anxiety disorders, ADHD and alcohol use disorders are also common (1). That is why, in someone who binge eats, a psychiatrist should also assess mood and drinking. Patients we treat for obesity whose drinking is hazardous are also referred to our addiction treatment clinic, where we provide treatment for alcohol dependence.

Is obesity medication alone enough if you binge eat?

GLP-1 obesity medicines (GLP-1 receptor agonists), such as semaglutide, reduce hunger. Stress, low mood, long gaps between meals and strict dietary restrictions can trigger binges. The medicine does not teach you other ways of coping with stress. Nor is it licensed for treating binge eating. We write about constant hunger and intrusive thoughts about food, including when there are no binges, in our article on constantly thinking about food.

In studies, semaglutide used to treat obesity reduced feelings of hunger and the frequency and intensity of sudden cravings. The Polish product information calls these emotional snacking (podjadanie emocjonalne), but this refers to a sudden urge to eat, not to binges with loss of control (7).

A 2026 review of studies of GLP-1 medicines in people with binge eating covered 12 studies of liraglutide, semaglutide and dulaglutide. They usually involved fewer than 75 people and had a short follow-up. In these studies, binges became less frequent, but the authors consider the evidence limited (8). Eating disorder specialists state that there is not enough evidence to treat the symptoms of these disorders with these medicines, and they do not rule out the possibility that the medicines make symptoms worse in some people (9). With a reduced appetite and nausea, a person may restrict their eating too much.

The authors of a 2025 meta-analysis also point out that symptoms of the disorder may come back after the medicine is stopped or when its effect wears off over time, but there are no long-term studies yet to check this (10). What happens to appetite and body weight after treatment ends is described in our article on stopping obesity medication.

Are there medicines for compulsive overeating?

The US Food and Drug Administration (FDA) has approved only one medicine for treating moderate to severe binge eating disorder in adults: lisdexamfetamine (1). In Poland, lisdexamfetamine is licensed only for treating ADHD (11). Some antidepressants and anti-epileptic medicines have also reduced the number of binges, but mainly in short studies. The UK's NICE guidelines recommend not treating binge eating with medication alone (4).

How is binge eating disorder treated?

The first-line treatment is psychotherapy. The best studied is cognitive behavioural therapy focused on eating disorders (CBT-ED), and interpersonal therapy and dialectical behaviour therapy are also effective. After this treatment, binges stop in roughly half of people (1).

The NICE guidelines suggest these forms of therapy, in this order (4):

• Guided self-help using materials based on cognitive behavioural therapy, supported by a specialist: over 16 weeks, the patient has, for example, 4 to 9 short sessions of about 20 minutes each
• Group cognitive behavioural therapy, if self-help does not bring improvement after 4 weeks or does not suit the patient; it usually involves 16 weekly 90-minute sessions over 4 months
• Individual cognitive behavioural therapy, if group therapy is not available or the patient does not want it; it usually involves 16-20 sessions

During therapy, the patient eats regular meals and snacks so as not to become very hungry. They record their binges and the circumstances in which they happened, and together with the therapist they look for the emotions and situations that trigger binges. They also work on their body image and on a plan in case of relapse (4).

In a review of 81 studies involving more than 7,500 people, patients who received psychotherapy, mainly cognitive behavioural therapy, had markedly fewer binges than people waiting for treatment. Medicines reduced the number of binges only slightly more than placebo. However, the authors rate most of the evidence on binges as very low quality (12).

Psychotherapy for binge eating has little effect on body weight, and weight loss is not its goal. However, once the binges stop, weight may go down over time (4).

Who treats binge eating?

According to the Polish guidelines, psychotherapy should be provided by an experienced psychotherapist who is a psychologist or a psychiatrist (3). A psychiatrist makes the diagnosis, assesses whether there is depression or another disorder and decides about medication. According to these guidelines, the patient should be referred to a psychiatrist or clinical psychologist if screening points to an eating disorder or if the symptoms make treatment harder for them. Which doctor to see about obesity alone is described in our article on where to start obesity treatment.

Can obesity be treated if you have binge eating episodes?

Obesity can be treated if you have binge eating episodes, but the treatment plan has to take them into account, and the order of treatment is best agreed by the doctor together with the psychotherapist. The NICE guidelines recommend not trying to lose weight, for example by dieting, during therapy for binge eating, because this is likely to trigger binges (4).

An American study included 136 people with binge eating disorder and obesity. It tested a 16-week behavioural weight-loss programme, meaning a moderate change in eating and physical activity guided by psychologists. The programme reduced the number of binges. After 16 weeks, binges had stopped in 37% of people in the programme group who received placebo instead of the medicine, and in 18% of those who received placebo alone. In the same two groups, 31% and 12% respectively lost at least 5% of their body weight. The researchers also tested a medicine containing naltrexone and bupropion. It led to binges stopping more often than placebo did, but it did not significantly reduce body weight, and it is not licensed for treating binge eating (5, 13).

The results of studies comparing weight-loss programmes with psychotherapy are mixed. In some, the programme reduced the number of binges as much as cognitive behavioural therapy, and in others less. It did, however, usually lead to greater weight loss in the short term (14). The authors of a 2022 review believe that people with a high BMI and obesity-related conditions may benefit from having their obesity and their eating disorder treated at the same time. However, it is not known which order of treatment works best (1).

Binge eating disorder in itself does not rule out bariatric surgery, but the psychological assessment before surgery covers symptoms of eating disorders, and binges may come back after the operation (1, 3).

What should you tell your doctor about binge eating before obesity treatment?

Before choosing a medicine, the doctor should know:

• How often you have binges and since when
• Whether you vomit after binges, take laxatives or diuretics, starve yourself or exercise very intensively
• Whether you have ever been diagnosed with bulimia or anorexia nervosa, because this rules out some obesity medicines
• Which diets you have followed before and how your weight changed afterwards
• What your mood and sleep are like, how much alcohol you drink and which psychiatric medicines you take

If you have binge eating episodes, it helps to tell your doctor about previous diets, weight fluctuations and long periods of restricting your eating. Why weight comes back after repeated diets is explained in our article on the yo-yo effect.

How does obesity treatment at Nasz Gabinet work if you have binge eating episodes?

At Nasz Gabinet, we treat obesity in adults in a 6-month online programme. The doctor diagnoses the condition based on BMI and waist circumference, assesses blood test results and discusses any eating disorders with the patient. On this basis, in line with the Polish guidelines, the doctor decides whether to prescribe medication. The programme includes video consultations with a doctor and with a psychologist, but a conversation with a psychologist does not replace psychotherapy for binge eating disorder, which in its individual form usually involves 16 to 20 sessions. If the doctor or psychologist suspects this disorder, they recommend treatment with a psychiatrist or psychotherapist. If you want to start obesity treatment and you have binge eating episodes, tell the doctor about them at your first consultation, because the decision about medication and the order of treatment depend on it.

When does binge eating need urgent medical help?

See a doctor straight away if:

• You make yourself vomit after eating or take laxatives or diuretics. The doctor will then check your blood electrolytes; severe electrolyte disturbances and dehydration are treated in hospital. Laxatives and diuretics do not reduce the number of calories your body absorbs, so they do not help you lose weight (4).
• Your weight is falling very quickly, you are eating extremely little or you are afraid of food, including during treatment with obesity medication (10).

Anyone who is thinking about harming themselves or taking their own life needs medical help immediately, without waiting for an appointment at a clinic. In an emergency, you can go to a psychiatric hospital without a referral (15).

Frequently asked questions

Is emotional eating an illness?

Emotional eating is neither an illness nor a diagnosis. The Polish obesity treatment guidelines describe it as one form of emotional hunger and note that it is a colloquial term. Seek help when this kind of eating causes distress, makes everyday life or obesity treatment harder, or comes with a loss of control. In that case, talk to a doctor or psychologist.

Can you have binge eating episodes if your weight is normal?

Yes, binge eating episodes also happen in people of normal weight. The diagnostic criteria for the disorder do not include body weight: what counts is the binges, the loss of control and the distress. In the WHO study, in which participants reported their own height and weight, 25 to 34% of people with binge eating disorder or bulimia had a normal weight, and 33 to 42% had obesity (6). A normal weight therefore does not rule out the disorder and is not a reason to put off seeing a specialist.

Is binge eating an addiction, like alcoholism?

Food addiction is not a separate diagnosis in disease classifications, and the Polish guidelines list it among unclassified disorders (3). It often occurs together with binge eating, but researchers consider it a separate phenomenon, which has also been described in people without eating disorders (16). Binge eating is treated differently from alcohol dependence. The aim of therapy is regular meals and snacks without binges.

Can binge eating go away without treatment?

The WHO study does not show whether the binges stopped on their own or after treatment. According to its participants, the disorder had lasted longer than 4 years in half of those affected, and longer than 11 years in one in four (6). Psychotherapy usually takes several months.

Sources

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