It has been a long day. You open the cupboard for a quick snack and, half an hour later, the table is covered in wrappers. You have eaten fast, without being hungry and without being able to stop. Then come the guilt, the shame and the promise that you will start a diet tomorrow.

If this keeps happening, it may not be a lack of willpower but binge eating disorder, a mental health condition that can be treated. If you are thinking about seeing a psychologist and looking for therapy for binge eating disorder, this guide explains when to seek help, which treatment works, what therapy looks like from the inside, why dieting is not advised, how long it takes, whether it works online and how to choose a professional.

When to see a psychologist for binge eating disorder

The NHS defines it as regularly eating a lot of food over a short period of time until you are uncomfortably full, without feeling in control of what you are doing, and describes it as a serious mental health condition. Binges are sometimes planned and sometimes spontaneous, they are usually done alone and they may include "special" binge foods. Men and women of any age can get it, although it often starts when people are in their twenties or older.

According to the NHS, you may have binge eating disorder if, as well as eating a lot of food in a short time and not being able to stop when full, you:

  • Eat when you are not hungry.
  • Eat very fast during a binge.
  • Eat alone or in secret.
  • Feel depressed, guilty, ashamed or disgusted afterwards.

The exact causes are not known, but the NHS lists several things that make it more likely: a personal or family history of eating disorders, depression or alcohol or drug misuse; being too worried about being slim, particularly if there is pressure from society or your job; anxiety, low self-esteem or perfectionism; and having been through a stressful event or trauma.

It is not rare. In the WHO World Mental Health Surveys, covering 24,124 adults in 14 countries, Kessler and colleagues found a median lifetime prevalence of 1.4%, higher than for bulimia, and fewer than half of those affected had ever received treatment. Overeating on a stressful day is not the same thing: we explain the difference in Emotional eating: why it happens and how to tell it from real hunger.

The MyPsicoTest Eating Disorder Test devotes one of its areas to binge eating and compensating behaviours, with statements such as "I eat a clearly larger amount of food than normal in a short time, with the feeling that I cannot stop". It does not diagnose, but it helps you put a name to it before you seek advice. If, as well as bingeing, you make yourself sick, use laxatives or fast to compensate, do not wait to get help. And if you have thoughts of harming yourself, call the 024 line in Spain (free, confidential, around the clock), 112, or your local emergency number.

Which treatment works for binge eating disorder

NICE, the body that issues clinical guidance in England, recommends a stepped approach. The first step is a guided self-help programme focused on binge eating: cognitive behavioural therapy materials you work through yourself, supported by short sessions, for example four to nine sessions of 20 minutes over 16 weeks. If that is not suitable for you or has not worked after four weeks, the next step is group eating-disorder-focused cognitive behavioural therapy (CBT-ED), and if no group is available or you prefer not to join one, individual CBT-ED.

The research supports that order. A meta-analysis by Hilbert and colleagues, covering 81 trials and 7,515 people, found that psychotherapy, mostly cognitive behavioural therapy, had large effects on reducing and stopping binge eating, that structured self-help had medium to large effects and that medication had small effects. The authors do warn that the quality of the evidence was generally very low.

What therapy for binge eating disorder looks like from the inside

NICE sets out what cognitive behavioural therapy for binge eating includes:

  1. Understanding the problem and keeping a record: what you eat, when, and what was happening before each binge.
  2. Eating regularly: a daily plan of meals and snacks so you do not reach the afternoon or evening ravenous.
  3. Spotting the triggers: tiredness, loneliness, stress or an argument, and working on the emotions that come with them through cognitive restructuring, behavioural experiments and exposure.
  4. Working on body image, with body exposure exercises and by questioning negative beliefs about your body.
  5. Preventing relapse, knowing what to do about current and future risks and triggers.
Person filling in a weekly meal plan with breakfast, lunch, dinner and snacks, as done in therapy for binge eating disorder

What about dieting?

This is what surprises people most. NICE asks for it to be explained from the start that psychological treatments for binge eating have a limited effect on body weight and that weight loss is not a therapy target in itself, although stopping binge eating can have that effect in the long term. It advises not trying to lose weight during treatment, because this is likely to trigger binge eating. The NHS puts it the same way: do not diet while you are having treatment, because it can make it harder to stop binge eating.

What about medication?

NICE says medication should not be offered as the only treatment for binge eating disorder. The NHS adds that an antidepressant is sometimes combined with therapy to treat other problems that come with it, such as anxiety, depression, social phobia or OCD. Medication is always decided by a doctor.

How long therapy for binge eating disorder takes

It depends on which step you start at. The guided self-help NICE describes lasts around 16 weeks; group therapy, 16 weekly 90-minute sessions over about four months; and individual therapy, between 16 and 20 sessions. The NHS points out that most people recover with the right support and treatment, although it may take time.

Does online therapy work for binge eating disorder?

It depends on what you mean by online. If it is therapy with a therapist by video call, a meta-analysis published in the CMAJ, covering 54 trials and 5,463 patients, found little to no difference between therapist-guided remote and in-person cognitive behavioural therapy, although only five of those trials were on body image or eating disorders.

Internet self-help programmes are a different matter. In the INTERBED trial, published in JAMA Psychiatry with 178 adults, an eleven-module programme with weekly email contact did worse than 20 sessions of face-to-face therapy at the end of treatment and at six months, although by eighteen months there was no longer a difference. If you have never had therapy by video call, Online psychologist: how to choose well and what to expect from video-call therapy may help.

How to choose a psychologist for binge eating disorder

These checks help you get it right:

  • Registration as a health professional. This comes first.
  • Experience with eating disorders and with cognitive behavioural therapy for binge eating. NICE asks for treatment to be based on manuals focused on eating disorders.
  • Someone who does not put you on a diet. If the plan starts with weight loss, it goes against what NICE and the NHS recommend.
  • Teamwork with your doctor and, if needed, with nutrition professionals.
  • Work on emotions and body image, as well as food.
  • A space free of judgement about your weight. NICE points out that people with an eating disorder are particularly vulnerable to stigma and shame.
  • Flexibility: online sessions if travelling is hard for you. And if you are looking for help for a family member, How to help someone with an eating disorder: what to say and what to avoid may be useful.

A psychologist for binge eating disorder

At MyPsicoTest we recommend Xènia Capel Salcedo, a licensed clinical psychologist (COPC 14982) with a master's degree in Clinical Psychology and Psychotherapy whose specialties include eating disorders. She sees clients in Igualada and Sant Sadurní d'Anoia and also through online therapy, and on her blog she has written an article about binge eating disorder. In it she explains that treatment addresses the emotional relationship with food, emotional regulation so there are alternatives to bingeing, nutritional support to restore regular eating patterns and body image without focusing on weight, with EMDR if there is underlying trauma. On her website she stresses that eating disorders are best treated through multidisciplinary work, and in another article she explains that online therapy for these disorders follows the same protocols as in-person therapy. She works from an integrative, evidence-based approach: on her website she explains that she uses tools from cognitive behavioural therapy, EMDR, systemic therapy and person-centred therapy. Sessions are available in English, Spanish or Catalan, and the first contact is a free, no-commitment information consultation. She herself points out that in a serious crisis or psychiatric emergency, immediate in-person care is what is needed.

If your result worries you or you want a professional assessment, you can talk to Xènia Capel Salcedo, a licensed psychologist (COPC reg. 14982), who offers a free first consultation call and online therapy from anywhere.

MyPsicoTest team · Updated: