Binge Eating Disorder and Alexithymia: When Feelings Are Experienced as Hunger

Binge Eating Disorder (BED) is the most common eating disorder, affecting approximately 2–3% of adults and up to 8% of individuals with obesity (Grillo, 2002). It is characterized by recurrent episodes of eating large quantities of food accompanied by a painful sense of loss of control, followed by guilt, shame, and self-criticism. While BED is often framed as a problem of eating behavior, research and clinical experience suggest that it is more accurately understood as a disorder of emotional regulation.

BED is influenced by multiple risk factors, including familial, psychological, interpersonal, genetic, and neurobiological factors (Waller, 2002; de Zwaan et al., 1995). Early in the course of the disorder, binge eating may be driven by physiological hunger related to dietary restraint. Over time, however, binge eating increasingly functions as a way to manage emotional states.

One significant vulnerability in the development and maintenance of BED is alexithymia - the difficulty identifying, understanding, and expressing feelings.

What Is Alexithymia?

The term alexithymia means “no words for feelings” and describes individuals who struggle to recognize emotions and often experience feelings as physical sensations (Sifneos, 1972). For example, sadness, loneliness, or anxiety may be experienced as hunger, fatigue, or bodily discomfort rather than as emotions (Wheeler, Greiner, & Boulton, 2005).

Alexithymia is associated with concrete, externally focused thinking, limited fantasy life, and difficulty reflecting on internal experience (de Zwaan et al., 1995). While it appears across many psychological conditions, research shows that alexithymia is more strongly associated with BED than with anorexia nervosa or bulimia nervosa (Wheeler et al., 2005).

Early relational experiences such as trauma, emotional misattunement, or a mismatch between a child’s temperament and caregiver responses can interfere with the development of emotional awareness. When caregivers are unable to help a child name and regulate feelings, the child may not develop internal mechanisms for self-soothing.

Binge Eating as Affect Regulation

For individuals with alexithymia, binge eating can become a powerful tool for regulating overwhelming or undefined emotional states. Food offers comfort, numbing, and temporary relief when other forms of emotional regulation are unavailable. Unlike substances such as drugs or alcohol, food is socially acceptable, easily accessible, and allows individuals to maintain daily functioning.

Woman eating in the shadows

Binge eating acts as a “blocking agent” to strong affective states (Waller, 2002). Because emotions are not consciously identified or processed, the individual often cannot recall what they were feeling before the binge. This reinforces alexithymia and prevents emotional learning. After the binge, shame and self-criticism emerge, often leading to restrictive eating or rigid rules, which in turn increase vulnerability to future binge episodes.

Treatment Implications

When BED is understood as a consequence of impaired emotional awareness, treatment must focus on more than symptom reduction. Core therapeutic goals include helping individuals identify feelings, tolerate emotional states, and develop more flexible ways of regulating affect.

Interventions that enhance emotional awareness - alongside a stable, attuned therapeutic relationship - are particularly important. Research supports that reductions in binge eating are associated with improvements in alexithymia and emotional awareness following treatment (Wheeler et al., 2005).

From this perspective, binge eating is not simply about food. It is an attempt to manage feelings that have not yet found words.

Carano, A., De Berardis, D., Gambi, F., Di Paolo, G., Campanella, D., Pelusi, L., Sepede, G., Mancini, E., La Rovere, R., Salini, G., Cotellessa, C., Salerno, R. M., & Ferro, F. M. (2006). Alexithymia and body image in adult outpatients with binge eating disorder. International Journal of Eating Disorders, 39(2), 332–340.

de Zwaan, M., Bach, M., Mitchell, J. E., Ackard, D., Specker, S. M., Pyle, R. L., & Pakesch, G. (1995). Alexithymia, obesity, and binge eating disorder. International Journal of Eating Disorders, 17(2), 135–140.

Grillo, C. M. (2002). Binge eating disorder. In C. G. Fairburn & K. D. Brownell (Eds.), Eating disorders and obesity: A comprehensive handbook (2nd ed., pp. 178–182). Guilford Press.

Sifneos, P. E. (1972). Short-term psychotherapy and emotional crisis. Harvard University Press.

Waller, G. (2002). The psychology of binge eating. In C. G. Fairburn & K. D. Brownell (Eds.), Eating disorders and obesity: A comprehensive handbook (2nd ed., pp. 98–107). Guilford Press.

Wheeler, K., Greiner, P., & Boulton, M. (2005). Exploring alexithymia, depression, and binge eating in self-reported eating disorders in women. Perspectives in Psychiatric Care, 41(3), 114–123.