Binge Eating Disorder and Emotional Regulation: Understanding the Role of Alexithymia

What Is Binge Eating Disorder (BED)? Understanding Symptoms and Causes

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.

Alexithymia and Binge Eating Disorder: When Feelings Become Physical

One significant vulnerability in the development and maintenance of binge eating disorder is alexithymia — the difficulty identifying, understanding, and expressing feelings.

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 binge eating disorder 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 Emotional Regulation: How Food Becomes a Coping Strategy

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. In this way, binge eating can become an invisible coping strategy.

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 food rules. This cycle increases vulnerability to future binge episodes and further entrenches emotional dysregulation.

Treatment for Binge Eating Disorder: Improving Emotional Awareness and Regulation

When binge eating disorder is understood as a consequence of impaired emotional awareness, treatment must focus on more than symptom reduction.

Effective treatment for binge eating disorder includes:

• Increasing emotional awareness

• Learning to identify and name feelings

• Building tolerance for uncomfortable emotional states

• Developing flexible, healthier forms of affect regulation

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.

Binge Eating Disorder Treatment in Cary, Apex, and Raleigh, NC

I provide psychotherapy for binge eating disorder in Cary, Apex, and Raleigh, North Carolina, with a focus on emotional awareness, affect regulation, and the deeper relational patterns that shape eating behaviors. My approach is thoughtful, collaborative, and grounded in helping you develop a clearer understanding of your emotional life so that food no longer has to carry what feels overwhelming. Contact me for a consultation.

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Resources

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.