How Binge Eating Disorder Develops and Persists in Teens

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Binge eating disorder (BED) is a serious mental health disorder that usually develops during the late teens. Teenagers with BED engage in frequent, recurrent episodes of binge eating. Binge eating is when someone eats a large amount of food while experiencing a sense of loss of control over eating. 

Binge eating disorder is about more than just food or eating. Adolescents with BED may use food to cope with painful emotions, thoughts, or memories. Binge-eating episodes, in turn, often exacerbate or lead to feelings of guilt, shame, or self-hatred that can cause further binge-eating behaviours.

While there is no single cause for binge eating disorder, there are several different risk factors that make the development of BED in teens more likely. This blog explores these risk factors and outlines some of the developmental pathways to binge eating disorder. It also outlines the emotional-behavioural cycles that can cause the disorder to persist in young people.

What Is Binge Eating Disorder?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), binge eating disorder is characterised by recurrent binge eating episodes involving:

  • the consumption of a large amount of food
  • a sense of loss of control over eating

Alongside binge eating episodes, people with BED may experience:

  • eating much more quickly than usual
  • eating until they feel uncomfortably full
  • eating a lot of food when they are not hungry
  • eating alone because of feelings of embarrassment or shame
  • feeling depressed or guilty after eating

Some experts think that these criteria aren’t always suitable for children and teenagers. They say that it’s not always clear to a young person what classifies as a large amount of food, especially as young people are growing up and their nutritional needs change. Instead, they prefer to focus on the feelings, emotions, or behaviours that accompany episodes of eating.

These might include:

  • seeking food in response to negative feelings (such as sadness or boredom)
  • using food as a reward
  • hiding food

How Does Binge Eating Disorder Develop in Teens?

Scientists still aren’t sure exactly how binge eating disorder develops. But most agree that there’s no single pathway to eating disorders. Instead, different factors interact in distinct ways for each young person, ultimately leading to BED. 

Researchers have identified several different risk factors that may contribute to the development of the disorder. These include difficulties regulating emotions, low self-esteem, co-occurring mental health conditions and experiences with dieting.

Low Self-Esteem

Teenagers with low self-esteem tend to be self-critical while downplaying or ignoring positive aspects of their self. They may hold negative beliefs about their appearance, character, behaviours, or accomplishments. 

Research shows that people with binge eating disorders have significantly lower self-esteem than people without eating disorders. Low self-esteem may cause feelings of distress that teens try to relieve through eating. However, binge-eating episodes typically exacerbate their distress, leading to feelings of guilt or self-loathing that reinforce their negative self-beliefs.

Studies have also linked overvaluation of shape and weight and body dissatisfaction with binge eating disorder. Overvaluation of shape and weight is much more common among individuals with BED than those without eating disorders and is about as prevalent as among anorexia nervosa and bulimia nervosa. It may lead to increased psychological distress for young people with BED, as well as more disordered eating attitudes.

Emotional Regulation and Psychological Distress

Some experts think that binge eating is a way to ‘escape’ from negative emotions, such as sadness, loneliness, or shame. Binge eating may be used as a coping mechanism by teens who struggle to manage (regulate) their emotions or lack other forms of support. In the short term, binge eating can create a distraction from these feelings; but their distress usually returns immediately after an episode.

This means that young people who have more difficulty regulating their emotions or frequently experience psychological distress may be more likely to develop binge eating disorder. Emotional deregulation and psychological distress may, in turn, have many causes. 

These might include anxiety, depression, low self-esteem, present stressful events, or past traumas, including childhood abuse, bullying, or mental illness in the family. Each of these factors makes the development of eating disorders more likely.

Experts note that younger teens may not always consciously connect their binge-eating episodes with difficult emotions. Instead, they might sometimes describe the experience as zoning out or numbing out. But these episodes may still be a subconscious way of dealing with adverse feelings, temporarily detaching a young person from their emotions.

Dietary Restraint

A growing body of research shows a causal link between dieting (restricting energy intake) and binge eating. This means that young people who restrict their diets in some way are more likely to engage in binge eating episodes. When someone restricts their diet, their body can go into ‘starvation mode’, causing intense cravings for restricted foods and other changes in the body that make binge eating more likely.

Binge eating and restriction may also tap into a teenager’s reward system. When a young person is restricting their diet, the ‘reward’ of eating becomes much greater and may lead to out-of-control episodes of eating.

How Does Binge Eating Disorder Persist in Teenagers?

The characteristics of binge eating disorder can create negative cycles that reinforce binge eating behaviour. This means that once a teenager develops binge eating disorder, it can be very difficult to stop binge eating without effective support.

Teenagers may binge eat as a way to cope with psychological distress, such as depression, anxiety, or self-criticism. Binge eating, however, is often followed by increased distress, self-loathing, and guilt. These feelings can affect a young person’s general well-being and perception of themselves, causing more painful emotions that lead to binge-eating episodes.

What Binge Eating Disorder Treatment Is Available for Young People?

Scientists still don’t have a lot of information about treating binge eating disorder in teenagers. Most studies on treatment approaches only involve adults, with very little research exploring BED in adolescents.

Among adults, there are several different evidence-based binge eating disorder treatment approaches proven to support long-term recovery. These include:

  • Cognitive-behavioural therapy – CBT focuses on making positive changes to eating patterns and identifying and adapting thoughts that contribute to binge eating episodes
  • Interpersonal psychotherapy – IPT aims to resolve the interpersonal difficulties that may lead to difficult emotions and an absence of effective support, underpinning binge eating episodes
  • Dialectical-behavioural therapy – DBT encourages radical acceptance, encouraging individuals to accept their emotions while making helpful changes to their thought patterns and behaviours

A small number of studies have assessed the effectiveness of these treatments among young people. These studies suggest that CBT, IPT, and DBT can also be effective for teenagers with BED. Family therapies, or other involvement of the family, may also play an important role in children’s and adolescents’ recovery.

Treating Co-Occurring Disorders

For some teens, binge eating episodes may be driven by other mental health conditions, such as depression, anxiety, or post-traumatic stress disorder (PTSD). These co-occurring disorders may cause difficult emotions that teens try to cope with using food.

Treating co-occurring disorders and past experiences of trauma alongside binge eating disorder treatment is really important. If less unaddressed, co-occurring disorders can cause teens to return to binge eating after the end of treatment. They can also complicate the treatment process, making it harder for young people to overcome disordered eating behaviours.

The Wave Clinic: Specialists in Binge Eating Disorder Treatment for Teens and Young Adults

The Wave Clinic offers specialist recovery programs for young people with eating disorders, borderline personality disorder, and other mental health concerns. Our team is made up of experts on child and adolescent mental healthcare from around the world, combining their experience and knowledge in individualised programs for each young person. 

Our programs focus on building self-confidence, developing life skills, and finding the stability and resilience necessary to navigate life’s challenges. We combine clinical care with personal learning plans, vocational education, and inspiring experiences, supporting young people to develop a secure sense of self that they believe in.

We appreciate the impact of trauma on many young people’s inner and outer world. We integrate trauma treatment into our eating disorder programs from the start of treatment, promoting inner healing and whole-person change.

As a Global Centre of Excellence for the treatment of eating disorders, we know the best way to support young people. If you’d like to find out more, contact us today.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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