If you’re like most Americans, you probably overeat once in a while. You might polish off a pint of ice cream in front of the TV and later think, “Why did I do that?”

But if you do this regularly and feel you can’t control yourself, or if you binge in secret and are filled with shame afterward, you may have binge eating disorder (BED).

Katie Foster, a stay-at-home mom in Newport, Michigan, struggled with binge eating disorder in her early twenties. At the time, she was 100 pounds overweight and fighting an overwhelming desire to binge on sweets. “I get this urge to fill my mouth, chew really fast and swallow over and over again,” she wrote in her journal at the time. “And as much as my stomach hurts afterwards, I crave that full feeling in my stomach. When I even think about restricting food, I get very anxious.”

Fast-forward seven years. Today, Foster, 33, has her binges under control. Beginning in 2009, she lost the extra 100 pounds thanks to diet and exercise and has kept the weight off ever since. She runs marathons, blogs about binge-eating and has even convinced her husband to drop 90 pounds. “Once in a while, I have a dream that I binge like I used to, and it makes me feel horrible,” she says. “When I wake up, I’m so relieved it’s just a dream.”

Related: Are You Sleep-Eating Without Knowing It?

A widespread disorder

BED is the most common type of eating disorder in the United States, affecting more people than anorexia and bulimia combined, according to the National Eating Disorders Association (NEDA). Unlike bulimia and anorexia, people with binge eating disorder don’t feel the need to purge (vomit) after they have binged. The federal Office on Women’s Health estimates that some 4 million people suffer from BED.

“BED is an eating disorder and very different from just emotional eating,” says Kari Anderson, DBH, clinical director at Green Mountain at Fox Run, a weight loss retreat in Ludlow, Vermont, and a board member of the National Association of Anorexia Nervosa and Associated Disorders (ANAD). “It needs specialized treatment from an eating disorder specialist.” 

Experts don’t know exactly what causes the disorder, but they believe genes, psychology and environment can all play a role. People with BED may have a history of abuse, addiction or trauma, and some suffer from depression or other mood disorders.

Anderson points out, however, that many BED patients have no serious psychological issues. Instead, she says, they have problems with motivation and keeping their emotions in check.

Related: Do Midnight Snacks Pile on the Pounds?

Do you have BED?

How do you know if you have BED? According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), you can be diagnosed with BED if you have been binging at least once a week for at least three months and exhibit some of these behaviors:

  • eating a large amount of food in a relatively short amount of time
  • feeling a lack of control during the binge
  • eating extremely fast
  • eating beyond feeling full
  • eating large amounts of food when not hungry
  • eating alone to hide how much you're eating
  • feeling bad about yourself after a binge

Getting help

Treatment for BED depends on you and whatever underlying issues triggered the disorder, according to Anderson.

The first priority is usually to stop the binging, then to figure out what patterns or emotional issues are contributing to it, Anderson says. This often leads to weight loss, but weight loss is not the main goal, according to the Office on Women’s Health. In fact, therapists often discourage rapid weight loss because that weight will likely come back, and severe cutbacks in calories may lead to more binging.

In 2015, the FDA approved the use of the drug Vyvanse, a stimulant used to treat ADHD, to treat BED. This is the first time the FDA has approved a medication for BED, but Anderson notes that therapists have prescribed ADHD medications off-label for years to BED patients because they appear to have problems with managing life tasks (known to clinicians as “executive functioning”).

Like many drugs, though, Vyvanse may work in part because of the placebo effect. One analysis of 10 clinical trials of BED medications found that more than a fourth of the participants stopped binging after receiving a placebo, or sugar pill, according to a 2014 article published in the European Eating Disorders Review.

Still, some therapist believe ADHD drugs are worth exploring, at least temporarily. “ADHD meds make sense,” says Anderson, “it’s a great ‘jump start’ to improve confidence to reduce binge eating, but long term use may create dependence issues because it is a stimulant.” Eventually, she says, people with BED need to seek therapy to work on regulating their emotions, perhaps including sessions on “mindful eating” or group therapy to break down feelings of shame and isolation.

Related: Break Your Addictive Food Habit

Where to start

If you think you or someone you know may have BED, there are plenty of places to go for help, including the National Eating Disorders Association (NEDA) and the national Association of Anorexia Nervosa and Associated Disorders (ANAD).

Look for a therapist with experience in treating BED, not just eating disorders in general. Cautions Anderson: “Cookie cutter treatments for eating disorders don’t address the special needs of BED patients.”

And Katie Foster? She is grateful to have her eating under control, but like many people with BED, she still battles urges to binge. “I've had binge eating disorder the majority of my adult life, and it's a constant struggle for me,” she says. “I just want others who may be binge eaters to see that it is possible to get better. It takes a lot of determination, but it's worth it.”

Mary Purcell is a freelance writer and health researcher in Piedmont, Calif., with expertise in policy analysis. She has a master's degree in Latin American studies from Georgetown University.