Binge Eating Disorder
"Eating large amounts of food rapidly, beyond the point of comfortable fullness"
What is Chronic Migraine?
Binge Eating Disorder (BED) is the most common eating disorder in adults, characterized by recurrent episodes of consuming large quantities of food in a discrete period (typically within 2 hours), accompanied by a sense of loss of control over eating during the episode. Unlike bulimia nervosa, binge episodes are not compensated by inappropriate compensatory behaviors such as self-induced vomiting, fasting, or excessive exercise. The disorder is associated with significant distress, obesity, metabolic dysfunction, and psychological comorbidities including depression, anxiety, and impaired quality of life.
Healthy Function
What your body should do
A healthy relationship with food involves eating in response to physiological hunger and satiety cues rather than emotional triggers. The hypothalamus appropriately regulates appetite through ghrelin (hunger hormone) and leptin (satiety hormone), while the vagal nerve transmits satiety signals from the gut to the brain. Dopamine pathways in the reward system respond appropriately to food without hyperactivation. Emotional regulation occurs through multiple coping mechanisms, with food serving its primary biological purpose of nourishment rather than emotional regulation. The prefrontal cortex successfully regulates impulsive responses, and individuals can recognize appropriate portion sizes and stop eating when satisfied.
When Things Go Wrong
Signs of chronification
- Pain threshold lowers over time
- More frequent attacks
- Brain stays in alert mode
- Medication stops working
How This Develops
Understanding the biological mechanisms helps us target the root cause
Point 1
Understanding the mechanism helps us target the root cause rather than just treating symptoms.
Recognizing All Symptoms
Chronic migraine affects multiple systems. Understanding your symptoms helps us identify the underlying mechanisms.
Physical Symptoms
13 symptoms
- Eating until uncomfortably full or in pain
- Rapid eating during binge episodes
- Weight gain or obesity (BMI often >30)
- Frequent stomach discomfort, bloating, or indigestion
- Fatigue and low energy levels
- Sleep disturbances
- Joint pain (due to excess weight)
- Acid reflux or GERD symptoms
- Irregular menstrual cycles (women)
- Skin tags and acanthosis nigricans (insulin resistance markers)
- Headaches
- Muscle weakness
- Constipation or diarrhea
Cognitive Symptoms
11 symptoms
- Preoccupation with food, eating, and body image
- Obsessive thoughts about calories, macros, or food rules
- Difficulty concentrating due to food thoughts
- Memory problems and brain fog
- Decision-making difficulties regarding food
- Racing thoughts during binge episodes
- Cognitive rigidity around food rules
- Difficulty with impulse control
- Eating in a dissociative state (zoning out while eating)
- Secretive behavior around food
- Difficulty recognizing satiety cues
Emotional Symptoms
12 symptoms
- Loss of control during eating episodes
- Feelings of shame and embarrassment about eating
- Guilt and self-criticism after binge episodes
- Depression and low mood
- Anxiety, especially around meals
- Emotional numbing during binge episodes
- Feelings of worthlessness tied to body image
- Social isolation and withdrawal
- Irritability and mood swings
- Anxiety about eating in front of others
- Feeling disgusted with oneself after eating
- Hopelessness about recovery
Metabolic Symptoms
12 symptoms
- Insulin resistance and elevated fasting insulin
- Dysregulated blood sugar (reactive hypoglycemia or prediabetes)
- Elevated triglycerides
- Reduced HDL cholesterol
- Elevated LDL cholesterol
- Metabolic syndrome markers
- Chronic low-grade inflammation
- Thyroid dysfunction (often subclinical hypothyroidism)
- Polycystic Ovary Syndrome (PCOS) in women
- Elevated cortisol (HPA axis dysregulation)
- Leptin resistance
- Ghrelin dysregulation
Conditions That Occur Together
These conditions often coexist with chronic migraine due to shared mechanisms
Major Depressive Disorder
50-60% comorbidity rate; emotional eating as coping mechanism for depressed mood; shared neurobiological pathways involving serotonin and HPA axis dysregulation; binge eating temporarily elevates mood through dopamine release
Anxiety Disorders
30-40% comorbidity; anxiety about food, body image, and meals; anticipatory anxiety triggers binge eating as coping mechanism; GAD and social anxiety commonly co-occur
Obesity
BED is the most common eating disorder in obese individuals; 30-50% of obese individuals meet criteria for BED; bidirectional relationship where each condition worsens the other; metabolic dysfunction drives both
Type 2 Diabetes
Bidirectional relationship; insulin resistance promotes hunger and eating; binge eating worsens glycemic control; approximately 15-30% of type 2 diabetics have BED
Substance Use Disorders
15-20% comorbidity; shared reward pathway dysfunction involving dopamine; food bingeing may activate similar reward circuits as substances; cross-addiction patterns
Attention Deficit Hyperactivity Disorder (ADHD)
30-40% of BED patients have ADHD; impulsivity is a shared feature; dopamine dysregulation affects both reward and attention; executive dysfunction contributes to binge behavior
Post-Traumatic Stress Disorder (PTSD)
20-30% comorbidity; trauma often precedes BED development; dissociation used as coping can transfer to binge eating; hyperarousal triggers emotional eating; ACE score correlates with BED severity
Personality Disorders
20-30% comorbidity, particularly Borderline Personality Disorder; emotional dysregulation is core feature; impulsivity; self-harm behaviors may co-occur
Sleep Disorders
Poor sleep increases ghrelin and decreases leptin, promoting hunger; sleep deprivation impairs prefrontal cortex function and impulse control; obstructive sleep apnea common in obese BED patients
Polycystic Ovary Syndrome (PCOS)
Insulin resistance is central to both conditions; hyperandrogenism may affect impulse control; bidirectional relationship; approximately 25% of PCOS patients have BED
Conditions to Rule Out
These conditions can present similarly but have distinct features
Binge Eating Disorder
Eating large quantities, loss of control, guilt/shame
Recurrent episodes of binge eating without compensatory behaviors; episodes cause significant distress; at least once weekly for 3 months
Bulimia Nervosa
Binge eating episodes, feeling out of control, guilt after eating
Regular engagement in compensatory behaviors (vomiting, laxatives, fasting, excessive exercise) after binge episodes; weight typically normal or low
Night Eating Syndrome
Evening hyperphagia, consumption after awakening from sleep
Recurrent episodes of eating after awakening from sleep or evening hyperphagia; no loss of control; morning anorexia may be present; episodes not as large as BED binges
Kleine-Levin Syndrome
Excessive eating during episodes
Recurrent episodes of hypersomnolence, cognitive changes, and altered perception; episodes last days to weeks; primarily affects young males
Prader-Willi Syndrome
Hyperphagia, food preoccupation, obesity
Genetic disorder present from childhood; characteristic physical features; intellectual disability; hyperphagia is lifelong and driven by lack of satiety
Binge Eating in the Context of Obesity
Eating large quantities, overweight status
Binge Eating Disorder requires distress and loss of control; obesity without BED involves eating beyond energy needs without the psychological features
Compulsive Overeating
Frequent overeating, emotional eating
Not a formal DSM diagnosis; often used interchangeably with BED but lacks specific frequency and duration criteria
Food Addiction
Compulsive eating, difficulty controlling intake, continued use despite negative consequences
Not a formal diagnosis; concept from addiction medicine; focuses on addiction-like response to certain foods, typically high-sugar/high-fat items
What's Driving Your Migraines
Identifying the underlying causes allows us to target treatment effectively
Genetic Predisposition
40-60% - Family history of eating disorders increases risk 3-12x; genes involved in dopamine signaling (DRD2, DRD4), serotonin transport (5-HTTLPR), and melanocortin receptorsFamily history; genetic testing for relevant polymorphisms; epigenetic factors
Dopamine Reward Dysregulation
45% - Reduced dopamine D2 receptor availability in striatum creates reward deficiency; food bingeing temporarily compensates by increasing dopamine releaseClinical assessment of reward-seeking behaviors; neuropsychological testing; response to dopaminergic interventions
HPA Axis Dysregulation and Chronic Stress
40% - Elevated baseline cortisol from chronic stress increases food-seeking behavior; cortisol promotes visceral fat storage and sugar cravings; stress eating becomes coping mechanismCortisol testing (AM/PM); DHEA-S; ACTH; stress history (ACES); perceived stress scale
Leptin Resistance
35% - Elevated leptin from adipose tissue fails to signal satiety to hypothalamus; brain doesn't receive appropriate fullness signalsLeptin levels; BMI; body composition; assessment of satiety awareness
Insulin Resistance
30% - Insulin resistance drives hunger through multiple mechanisms; creates cyclical overeating that worsens insulin resistanceFasting insulin; HOMA-IR; HbA1c; glucose tolerance test
Serotonin Dysfunction
35% - Reduced serotonergic activity impairs mood regulation and impulse control; low serotonin associated with carbohydrate cravingsSerotonin levels; tryptophan ratio; clinical response to SSRIs
Early Life Trauma and Adverse Childhood Experiences
30-50% - ACEs strongly correlate with BED development; trauma disrupts emotional regulation capacity; food becomes substitute coping mechanismACE questionnaire; detailed trauma history; trauma screening tools
Dieting History and Food Restriction
40% - Chronic dieting and food restriction triggers physiological hunger and binge response; restriction creates preoccupation with food; cycles of deprivation and bingeDetailed dietary history; history of yo-yo dieting; restrictive eating patterns
Emotional Regulation Deficits
45% - Inability to identify, process, or regulate emotions; food used to numb, soothe, or distract from difficult emotionsDifficulties in Emotion Regulation Scale (DERS); emotional awareness assessment
Gut-Brain Axis Dysfunction
25% - Altered microbiome composition affects satiety signaling through vagal nerve; gut inflammation affects mood; dysregulated appetite signalsStool microbiome analysis; leaky gut markers; SIBO testing
Inflammation
25% - Elevated inflammatory cytokines (IL-6, TNF-alpha) affect hypothalamic function and increase food intake; chronic inflammation common in metabolic syndromeCRP, IL-6, TNF-alpha; metabolic markers
Cognitive and Executive Function Impairment
30% - Reduced prefrontal cortex function impairs impulse control and decision-making regarding food; working memory deficits affect food choicesNeuropsychological testing; continuous performance tests; Wisconsin Card Sorting Test
Key Laboratory Markers
These biomarkers help us understand your specific migraine mechanisms
What Happens If Left Untreated
Understanding the consequences helps you make informed decisions about your health
Obesity and Metabolic Syndrome
Months to yearsProgressive weight gain; 90% of BED patients are overweight or obese; metabolic syndrome develops with cardiovascular risk factors including hypertension, dyslipidemia, and insulin resistance
Type 2 Diabetes
YearsInsulin resistance progresses to type 2 diabetes in 30-50% of cases; requires lifelong medication and monitoring; increases risk of complications including neuropathy, retinopathy, and kidney disease
Cardiovascular Disease
Years to decadesElevated triglycerides, LDL cholesterol, and blood pressure; increased risk of heart attack, stroke, and peripheral vascular disease; obesity itself is independent cardiovascular risk factor
Severe Depression
Months to years60-70% of BED patients experience major depression; shame and isolation worsen depressive symptoms; treatment-resistant depression more common
Reduced Quality of Life
Immediate and progressiveSignificant impairment in multiple life domains; social isolation; difficulty with relationships; occupational difficulties; financial burden of food and healthcare costs
Suicide Risk
OngoingElevated suicide risk, particularly in those with comorbid depression and history of trauma; BED patients have 5x higher suicide attempt rate than general population
Gastrointestinal Complications
YearsGallbladder disease; fatty liver disease (NAFLD/NASH); gastroesophageal reflux; gastric dilatation and risk of rupture in severe cases
Reproductive Health Issues
VariableMenstrual irregularities; PCOS; reduced fertility; pregnancy complications including gestational diabetes and preeclampsia
Joint and Musculoskeletal Problems
YearsOsteoarthritis accelerated by obesity; joint pain limiting mobility; chronic pain syndrome; reduced physical activity worsening the cycle
Cognitive Decline
Years to decadesMetabolic dysfunction and chronic inflammation associated with accelerated cognitive decline; increased risk of dementia in later life
Time Matters
Don't wait for symptoms to worsen. Early intervention leads to better outcomes.
How is Chronic Migraine Diagnosed?
Comprehensive evaluation to identify triggers, contributing factors, and appropriate treatment
Comprehensive Metabolic Panel
Purpose:
Assess metabolic function and rule out complications
Glucose, HbA1c, insulin, lipids, liver function, kidney function
Hormone Panel
Purpose:
Assess endocrine function and metabolic drivers
Cortisol (AM/PM), DHEA-S, leptin, ghrelin, thyroid panel, testosterone (free and total)
Inflammatory Markers
Purpose:
Assess chronic inflammation
CRP (hs), IL-6, TNF-alpha
Nutrient Analysis
Purpose:
Identify deficiencies that may affect mood and cognition
Vitamin D, B12, folate, omega-3 index, zinc, magnesium
Stool Microbiome Analysis
Purpose:
Assess gut-brain axis contribution
Bacterial diversity; dysbiosis patterns; leaky gut markers
Food Sensitivity Testing
Purpose:
Identify inflammatory food reactions
IgG food antibody panel; identify reactive foods
Validated BED Questionnaires
Purpose:
Establish diagnosis and baseline severity
Binge Eating Scale (BES), Binge Eating Disorder Screener-7 (BEDS-7), Eating Disorder Examination Questionnaire (EDE-Q)
Psychological Assessment
Purpose:
Assess comorbidities and psychological features
PHQ-9 (depression), GAD-7 (anxiety), DERS (emotional regulation), ACE questionnaire
Body Composition Analysis
Purpose:
Assess metabolic risk
DEXA scan or bioimpedance; visceral fat; muscle mass
Continuous Glucose Monitoring
Purpose:
Assess blood sugar patterns
Glucose variability; reactive hypoglycemia patterns; glycemic response to foods
Our Integrative Approach
A comprehensive, phased approach to treat chronic migraine at its source
Comprehensive assessment, rule out medical causes, establish baseline
Comprehensive assessment, rule out medical causes, establish baseline
Complete medical and psychiatric evaluation,Physical examination including vital signs and BMI,Comprehensive laboratory testing (metabolic, hormonal, inflammatory),Validated BED assessment tools (BES, BEDS-7),Screen for comorbidities (depression, anxiety, trauma),Food diary and binge pattern assessment,Psychoeducation about BED neurobiology,Establish regular eating pattern (3 meals + planned snacks),Begin nutrient repletion if deficient,Stabilize blood sugar with regular meals
Reduce binge frequency, develop coping skills
Reduce binge frequency, develop coping skills
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Address underlying physiological drivers
Address underlying physiological drivers
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Sustain recovery, prevent relapse
Sustain recovery, prevent relapse
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Supporting Your Treatment
Evidence-based lifestyle modifications to enhance treatment effectiveness
What Success Looks Like
Binge eating episodes reduced to zero or minimal (<1 per month)
Restored ability to eat in response to hunger and satiety cues
Reduced or eliminated feelings of loss of control around food
Improved mood and reduced depression/anxiety scores
Stable eating patterns with regular meals
Resolution of shame and secrecy around eating
Improved body image and self-esteem
Improved metabolic markers (if elevated)
Enhanced emotional regulation capacity
Restored social functioning and relationships
Quality of life improvement
No longer meeting BED diagnostic criteria
Frequently Asked Questions
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