KidsMD Health Topics

Binge Eating Disorder

  • Binge-eating disorder is a newly recognized condition believed to affect millions of Americans. Most people with binge-eating disorder have frequent episodes of eating what others would consider an abnormally large amount of food, and frequent feelings of being unable to control what or how much is being eaten.

    Children and teens with binge-eating disorder may:

    • eat much more quickly than usual
    • eat until uncomfortably full
    • eat large amounts of food even when not hungry
    • eat alone out of embarrassment at the quantity of food being eating
    • feel disgusted, depressed and guilty after overeating

    This disorder is different from binge-purge syndrome (also known as bulimia nervosa) because people with binge-eating disorder usually don’t purge afterward by vomiting or using laxatives.

    Binge-eating disorder can have serious health consequences. Early diagnosis and treatment are extremely important.

    How Children’s Hospital Boston approaches binge-eating disorder

    The Eating Disorders Program at Children’s Hospital Boston provides comprehensive evaluation and treatment services every year to more than 200 adolescents with binge-eating disorder, anorexia nervosa, bulimia nervosa and related eating disorders. Staffed by expert specialists, the program addresses your child’s medical, nutritional and psychological needs in order to effectively treat her disorder.

    Our healthcare team also gives guidance to many providers in the northeastern United States and beyond.

    • Our providers also consulted on the National Eating Disorders Screening Project. They have advocated for insurance coverage for eating disorders at the Massachusetts State House, and give frequent presentations on eating disorders throughout New England.
      Binge Eating Disorder: Reviewed by Sara F. Forman, MD

      © Children’s Hospital Boston; posted in 2011

    Eating Disorders Program

    Boston Children's Hospital
    300 Longwood Avenue
    Boston MA 02115

      Fax: 617-730-0815



  • Our culture's obsession with achieving lower weight conveys an unavoidable message to maturing adolescents. According to the 2009 Youth Risk Behavior Survey, 33 percent of adolescent girls believed that they were overweight and 56 percent were attempting to lose weight.

    Adolescents with unrealistic expectations about weight may end up suffering from an eating disorder.  Read on to learn more about the causes and signs of eating disorders, as well as how Children’s Hospital Boston can help young adults struggling with an eating disorder.


    What causes eating disorders?

    It’s hard to pinpoint the cause of eating disorders, but there are several factors thought to be associated:

    • Social attitudes toward body appearance — often unrealistic — are believed to play a large role.

    • Adolescents who develop eating disorders are more likely to come from families with a history of weight problems, physical illness and mental health problems, such as depression or substance abuse. Genetics may also play a role.

    • Often teens with eating disorders come from families with high levels of stress, poor patterns of communication, unrealistically high expectations and underdeveloped problem-solving skills.

    • Sports or activities in which leanness is emphasized (e.g., ballet, running or wrestling) and sports in which scoring is partly subjective (e.g., skating or gymnastics) are associated with a higher incidence of eating disorders.

    • Teens with eating disorders often have other mental health problems, such as anxiety disorders, obsessive-compulsive disorder (OCD), affective (or mood) disorders and problems with substance abuse. They may also be dependent, immature in their emotional development and likely to isolate themselves from others.

    How can I tell if my child is “bingeing”?
    Bingeing is defined as eating much larger amounts of food than would normally be consumed within a short period of time (usually less than two hours). Eating binges occur at least twice a week for three months and may occur as often as several times a day.

    Signs and symptoms

    If your child has binge-eating disorder, some of the symptoms you may notice include:

    • recurrent episodes of binge eating (rapid consumption of excessive amounts of food in a relatively short period of time; often secretive), coupled with fearful feelings of not being able to stop eating during the bingeing episodes
    • eating a lot even when they don’t feel hungry
    • peculiar eating habits or rituals
    • anxiety
    • discouraged feelings related to dissatisfaction with themselves and their body appearance
    • depression
    • preoccupation with food, weight and body shape
    • weight fluctuations
    • food disappearing from the kitchen

    What are the warning signs to look out for?

    Eating disorders are illnesses of denial and secrecy; they're often very difficult to track down. So family members and friends shouldn't feel badly about not figuring out right away if their loved one has a problem.

    That being said, there are some signs you can look for:

    • weight gain
    • irritability or moodiness
    • hiding food
    • hoarding food
    • rapid disappearance of food from the kitchen

    Also be on the lookout for major change in eating or exercise behavior.

    What are the potential complications of binge-eating disorder?

    Binge-eating disorder is a serious disease. Here are some of the complications a young adult with bulimia may develop:


    Researchers are actively exploring the question of whether binge-eating disorder can be prevented.

    • Awareness increases the chance of early detection and intervention — which in turn can reduce the severity of symptoms, enhance your child's normal growth and development and improve her quality of life.

    • Encouraging healthy eating habits and realistic attitudes toward weight and diet may also be helpful.

    • To some extent, parents can help prevent eating disorders in their children:

    • Here at Children’s Hospital Boston, our doctors encourage parents to avoid using food as a behavioral reward and to provide variety in appropriate portion sizes.

    • Parents should carefully monitor growth and development, helping their children avoid obesity through sensible eating and physical activity.

    • Parents should stress health and fitness—not “thinness.”

    Long-term outlook

    Treatment for binge-eating disorder is still developing because it’s such a new condition. However treatment for most eating disorders is a slow process that may last years.

    The vast majority of adolescents suffering from binge-eating disorder will enter a recovery phase, but there may be a lifelong struggle with food and consequent weight loss or gain.

    When to seek medical advice

    If you notice changing eating or exercising habits in your child, it might mean that she has an eating disorder such as binge-eating disorder. You should make an appointment with your child’s pediatrician right away.

    If your child has already been diagnosed with binge-eating disorder, you should call her doctor if you see any further change in your child’s behavior relating to food or exercise.

    Useful medical terms

    Anorexia Nervosa (Anorexia) is an eating disorder characterized by self-starvation with or without over-exercise or purging. Anorexia is a complex disease involving psychological, sociological, and physiological elements.

    Anxiety disorder is a generalized term used to describe mental health disorders relating to excess worrying, phobias and nervousness. A person suffering from an anxiety disorder may have panic attacks and may be unable to pursue normal daily routines.

    Behavioral problem or disorder is a generalized term used when a child or teenager behaves—over a long period of time—in ways that are not socially acceptable for his or her age and situation or in ways that are destructive or self-destructive.

    Binge-eating disorder is an eating disorder characterized by frequent episodes of eating what others would consider an abnormally large amount of food and frequent feelings of being unable to control what or how much is being eaten.

    Bipolar disorder is a mood disorder characterized by severe mood swings. A person with this disorder may go from being manic, extremely elated and energetic to being depressed, sad, and sluggish. People with this disorder are sometimes known as “manic depressives.”

    Bulimia Nervosa (commonly known as Bulimia)is an eating disorder characterized by extreme overeating or “binge” eating followed by self-induced vomiting, excessive exercising, inappropriate use of laxatives or enemas or fasting.

    Clinician is an individual who is trained to practice medicine or psychological counseling and who works directly with people instead of in a laboratory.

    Depression (clinical) is a mental health disorder characterized by a sad mood that is both prolonged and severe. Clinical depression can be treated with medication, therapy, and hospitalization if necessary.

    Diagnostic evaluation refers to when a clinician assesses the symptoms presented by your child in order to come to an informed opinion about what condition is causing those symptoms.

    Dietician/Nutritionist refers to professionals with specialized training in nutrition. They, along with nurses and doctors, help families design healthy eating plans and provide long-term follow-up.

    Mood disorder is a generalized term referring to mental health disorders where a person’s general mood is distorted or inappropriate given the circumstances. Clinical depressionand bipolar disorder are both mood disorders.

    Nurse Practitioner refers to a person with an Advanced Practice Nurse (APN) degree who manages patient care and provides primary care services as well as specialty services. Unlike most nurses, nurse practitioners can diagnose patients and prescribe medications.

    Psychiatrist refers to a medical doctor who has specialized training in behavioral and mental health disorders. Psychiatrists can prescribe medication to their patients.

    Psychologist refers to a mental health professional who is not a medical doctor and who does not prescribe medication. Clinical psychologists have extensive training in therapy and psychological testing.

    Social Worker refers to a professional who patients and their families deal with the broad range of psychosocial issues and stresses related to coping with illness and maintaining health.

  • How is binge-eating disorder diagnosed?

    It can be hard to diagnose binge-eating disorder, since many adolescents with the disorder try to keep their illness very private and hidden. Parents, teachers, coaches or instructors may be able to identify a child or adolescent with binge-eating disorder, but the diagnosis is usually made by a qualified mental health professional or medical provider.

    Since early treatment can often prevent future problems, if you note symptoms of binge-eating disorder in your child, it’s a good idea to seek evaluation and treatment sooner rather than later.

    If an eating disorder is suspected, some components of the evaluation may include:

    • a careful patient and family history
    • physical examination
    • laboratory tests, including a complete blood count and a urinalysis
    • mental health and nutritional assessments

    To help diagnose binge-eating disorder, your child’s doctor will:

    • assess weight changes
    • inquire about self-perceptions of weight and desired weight
    • ask your child about bingeing and out-of-control eating and purging
    • ask your child about use of laxatives and diet pills
    • ask your child about:
      •  abdominal pain
      •  bloating
      • constipation
      • hair loss or change in hair texture
      • cold intolerance
      • fatigue
      • weakness
      • fainting
      • substance use
      • sexuality
      • depression
      • amount of physical exercise
      •  stress fractures

    Your child’s doctor will likely also conduct the following studies:

    • a social history — a review of risk factors focusing on the home, education and activities

    • a family history — information about conditions and disorders within the family, including eating disorders, obesity, alcoholism, depression or other mental illness

    • a physical exam —a clinician will assess and examine your child’s blood pressure, pulse, temperature, weight and height, skin and hair changes, heart function and abdomen.

    After we complete all necessary tests, Children’s experts will meet to review and discuss what they have learned. Then we will meet with you and your family to discuss the results and outline the best treatment options for your child.

  • Eating disorders like binge-eating are usually treated with a combination of:

    • individual therapy (usually including both cognitive and behavioral techniques)
    • family therapy
    • nutritional rehabilitation
    • behavior modification

    Medication (usually antidepressants) may be helpful if your child is also feeling depressed. It's important to remember that family members play a vital supportive role in any treatment process.

    The Eating Disorders Program at Boston Children's Hospital

    Children's Eating Disorders Program is committed to helping you, your child and your family at every step of the treatment process. The program uses a multidisciplinary approach for evaluation and treatment to help formulate an individualized treatment plan and make preliminary recommendations that will work best for your child's individual needs and circumstances.

    Providers in our Eating Disorders Program see both inpatients and outpatients —about 200 new cases annually. As outpatients, adolescents are seen by a physician from Children's Division of Adolescent Medicine, as well as a dietician. Your child will also see a psychologist or social worker with whom you can meet separately. Your doctor will recommend follow-up visits if necessary.

    If your child becomes really sick—her condition gets worse, causing unstable vital signs, for example—he or she will be admitted to the hospital. Inpatients are placed on the hospital's "Restrictive Eating" clinical practice guideline. This means they meet with the same types of caregivers as an outpatient would, while participating in a special meal plan with customized weight gain goals.

    What to expect at your appointment

    While no patient's experience is exactly like another's, below is a general idea of what you will experience when your child has an appointment in the Children's Eating Disorders Program.

    What to bring

    Please bring contact information for any providers your child is seeing (therapist, nutritionist, pediatricians).

    Your first appointment

    Your initial consultation will include:

    • A medical evaluation by a doctor skilled in adolescent medicine and eating disorder treatment. The doctor will assess your child's health by checking her height, weight, blood pressure, pulse and temperature, and will determine the severity of any existing medical complications she may have. Our doctor will contact your child's primary care provider to help coordinate care.
    • A mental health consultation with a counselor experienced in treating adolescent eating disorders. Fighting back against these disorders requires improving your child's body image and self-esteem and addressing other emotional issues.
      • During treatment, some adolescents discover they have other problems such as depression, obsessive-compulsive disorder or substance abuse. The therapist can assist in diagnosing these difficulties. Therapy can also be an important part of getting well if family tensions, relationships with friends or poor communication skills are disrupting your child's life.
    • A nutrition evaluation with a dietician. This can help you and your child create a safe eating plan and answer questions about food. Teens receive many mixed messages in a culture obsessed with fast food, dieting and body image. The dietician can discuss some of these harmful myths, and help your child design an individualized guide to achieving healthy eating and healthy living.

    Your additional appointments

    After the initial evaluation, the Eating Disorders Program will help you set up appropriate treatment. The program works with primary care providers to ensure a comprehensive treatment program. Referrals to local health care providers, as well as to providers At Boston Children's Hospital, are available.

    Treatment may involve:

    • Ongoing individual and family therapy
    • Medical monitoring
    • Nutritional support

    Coping and support

    It's essential to remember that, while learning that your child is struggling with anorexia nervosa can feel very isolating, many children and their families have been down this path before. We've helped them, and we can help you, too.

    There are lots of resources available for your family—within Children's, in the outside community and online. These include:

    Patient education:From the very first visit, our staff will be on hand to walk you through your child's treatment and help answer any questions you may have. And they'll also reach out to you by phone, continuing the care and support you received while at Children's.

    Parent to parent: Want to talk with someone else whose child has been treated for anorexia? We can put you in touch with other families who have been through similar experiences and can share their stories.

    Faith-based support:If you are in need of spiritual support, we'll help connect you with the Children's chaplaincy. Our program includes nearly a dozen clergy representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian and United Church of Christ traditions who will listen to you, pray with you and help you observe your own faith practices during the time you and your child are in the hospital.

    Social work and mental health professionals: Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to coping with illness and dealing with financial difficulties.

    On our For Patients and Families site, you can read all you need to know about:

    • getting to Children's
    • accommodations
    • navigating the hospital experience
    • resources that are available for your family

    Children's Behavioral Medicine Clinic helps children who are being treated on an outpatient basis at the hospital—as well as their families—understand and cope with their feelings about:

    • being sick
    • handling pain
    • taking medication
    • changes in friendships and family relationships
    • managing school while dealing with an illness
    • grief and loss

    Children's Psychiatry Consultation Service is comprised of expert and compassionate pediatric psychologists, psychiatrists, social workers and other mental health professionals who understand the unique circumstances of hospitalized children and their families. The team provides several services, including:

    • short-term therapy for children admitted to one of our inpatient units
    • parent and sibling consultations
    • teaching healthy coping skills for the whole family
    • educating members of the medical treatment team about the relationship between physical illness and psychological distress

    Children's Department of Psychiatry offers a free booklet, “Helping Your Child with Medical Experiences: A Practical Parent Guide”. (Please note that Adobe Acrobat is required to view and download the guide.) Topics in the booklet include:

    • talking to your child about her condition
    • preparing for surgery and hospitalization
    • supporting siblings
    • taking care of yourself during your child's illness
    • adjusting to life after treatment
    Multidisciplinary care

    One frequently used treatment for eating disorders involves an interdisciplinary team approach, involving a medical provider, dietician (with experience in treating eating disorders) and a mental health professional.

  • "Part of Children's mission is to take findings generated in its laboratories and translate them to the bedside, and the CTSU [Clinical and Translational Study Unit] provides the space and resources to make that possible."

    Catherine Gordon, MD, MSc, director of the Bone Health Program at Boston Children's Hospital

    In addition to our clinical practice, Children’s researchers are actively involved in finding new ways to understand, treat and prevent eating disorders like binge-eating disorder:


    A study led by Children’s researchers has shown an interesting paradox: People with anorexia have high levels of fat within their bone marrow. If the body isn’t getting enough nutrients, stem cells (the special cells that can change into other types of cells, like fat cells or blood cells) found in the bone marrow develop into fat cells, rather than bone-forming cells. This may help explain one serious consequence of anorexia — early and severe osteoporosis, or bone weakening.


    Another Children’s research initiative aims to find a way to prevent bone loss in teens and in healthy adults. Estrogen helps to maintain bone density in young adults with eating disorders. DHEA is a natural hormone that is also associated with preventing bone loss and strengthening bones. Through a combination of a low-dose estrogen therapy and DHEA, it may be possible to increase bone density.


    We all know that good nutritional habits and adequate exercise are key to staying healthy, but

    less clearly understood is the way social and physical environments play into these goals. Children’s researchers are investigating how school and community settings affect adolescent nutrition, physical activity and risk of eating disorders — and are working to design and evaluate school- and community-based interventions and preventive measures that encourage healthy nutritional habits.

    The Eating Disorders Program at Children's is actively involved in many other research projects aimed at providing a better understanding of adolescent eating disorders and developing new interventions. Our current projects include:

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