PCOS/PMOS and Binge Eating Disorder: Understanding the Connection

Many people have heard of polycystic ovary syndrome (PCOS) and binge eating disorder (BED). However, the conversation around having both is rarely addressed and oftentimes overlooked. Living with PMOS can be overwhelming as one has to manage unpredictable symptoms, body changes, and recommendations around food and weight. 

Adding binge eating disorder into the mix can further damage your relationship with food and negatively affect body image. Individuals with PCOS and binge eating disorder have to navigate the intersection between hormones, mental health, restriction, shame, and more. 

What is PCOS/PMOS?

Polycystic ovary syndrome (PCOS) is a common hormonal disorder characterized by a hormonal imbalance where the ovaries or adrenal glands produce high levels of androgen. It was renamed to polyendocrine metabolic ovarian syndrome (PMOS) to better reflect the complex metabolic, endocrine, and reproductive features beyond the presence of ovarian cysts. PCOS and PMOS are used interchangeably. Approximately 1 in 10 women are affected and it can co-occur with a variety of different disorders. For instance, it is associated with disordered eating and eating disorders such as binge eating disorder. It often takes multiple appointments for a diagnosis, and many women go undiagnosed.

Symptoms and features of PMOS that are associated with increased appetite, impaired impulse control, and body dissatisfaction include:

• • Insulin instability
  • Food cravings
  • Irregular menstrual cycles
  • Over production of androgen
  • Weight fluctuations

What is Binge Eating Disorder?

A binge eating disorder involves regularly eating much more food than what is considered “normal” in a short period of time. Individuals often report feeling like there is a loss of control over their eating behavior.

Common signs include:

• • • Eating until uncomfortably full
    • Consuming large portions of food despite a lack of hunger
    • Feelings of guilt, shame, or disgust after over eating
    • Feeling intense persistent food cravings

What is the connection between PMOS and binge eating?

Understanding the relationship between PMOS and binge eating disorder can help explain why eating patterns and weight can feel challenging for those living with PMOS. It affects both hormones and metabolism which can influence appetite, cravings, and hunger cues.

Insulin resistance: Individuals with PMOS experience difficulty using insulin effectively which can lead to blood sugar fluctuations that trigger intense hunger and cravings for highly processed or sugary foods. This cycle contributes to episodes of overeating or binge eating.

Hormonal shifts and imbalances: Hormonal fluctuations can trigger cravings for specific foods such as carbohydrates or sugary foods, which can in turn contribute to episodes of binge eating. Additionally, hormone imbalances may disrupt the body’s natural hunger and fullness cues. For example, changes in insulin, cortisol, and reproductive hormones can increase appetite and the intensity of cravings.

Overall health and healthy eating: Many of the recommendations typically made regarding strategies for healthy eating may not have the same effect on individuals with PMOS as they do for others because of the way PMOS affects metabolism and hormone regulation.  For example, elevated levels of androgens such as testosterone can directly stimulate appetite, affect impulse control, and contribute to emotional eating.  PMOS can also disrupt hormones such as leptin which signal hunger or fullness.  It can be quite discouraging when suggestions that seem to help others are not as effective for people with PMOS, which in turn may lead to repeated cycles of restricting and overeating.

Why is the connection between PMOS and binge eating important?

Common treatments for PMOS typically involve birth control, weight loss recommendations, and low carb diets, which can worsen binge eating behavior. The emphasis on weight management, diet, and physical activity can be extremely harmful alongside binge eating disorder. Because medical treatments focus heavily on weight loss and BMI, it may increase feelings of shame and reinforce the idea that a person’s worth is tied to their body size. 

Binge eating disorder can reinforce PMOS symptoms and create a cycle. For example, it can impact the body’s hormone production as episodes of binge eating contribute to blood sugar instability, changes in insulin levels, and disruptions in hormone production which can worsen PMOS symptoms over time. On top of this, experiences of body dissatisfaction and weight changes can increase feelings of shame and cause emotional distress. There is often avoidance in regard to seeking medical care because of the fear of weight bias and being blamed. As a result, treatment can get delayed as they feel like there is something “wrong” about their body.

What helps PMOS and binge eating?

Avoid restrictive diets: As mentioned previously, restrictive diets often do more harm than good. It can increase feelings of deprivation and intensify cravings which can contribute to binge eating episodes. A more productive alternative would be to create balanced and sustainable eating habits that allow flexibility while also supporting your health.

Focus on nourishing meals and mindful eating habits: This helps in rebuilding a healthier relationship with your body and food. Eating balanced meals that include protein, fiber, healthy fats, and satisfying carbohydrates can help stabilize energy levels and reduce hunger and cravings. Mindful eating practices such as slowing down during meals, paying attention to your body’s signals, and eating without judgement can support greater awareness of the body’s needs and reduce the emotional distress that is connected with eating.

Lifestyle changes: Gentle movement, stress management, getting quality sleep, and hydration all play an important role in improving hormone regulation and overall health. Implementing more movement and exercise does not need to be intense. Small, realistic changes can be more beneficial than extreme routines that quickly lead to burnout and frustration. Extreme routines are more likely to contribute to the cycle as they can be difficult to sustain.

Seek professional support: Find therapists and dietitians who understand eating disorders and co-occurring diagnoses. Psychologists can help with the emotional and psychological challenges related to binge eating disorder and PMOS while also working collaboratively with dietitians to help the individual learn how to nourish their body in a balanced way. In doing so, the collaboration between professionals ensures that the individual is receiving the proper care and attention they deserve.

Therapy can break the binge cycle that is often associated with self-criticism, rigid all-or-nothing thinking, and negative narratives about oneself and one’s body. Therapy helps identify triggers related to binge eating disorder and supports the development of healthier coping skills and strategies for emotional regulation, distress tolerance, as well as challenging cognitive distortions. It also addresses co-occurring issues that may be impacting one’s sense of self, body, relationship to food, and physical activity. Common co-occurring issues include anxiety, depression, and interpersonal problems.

Dietitians can help normalize eating patterns and identify which foods best nourish one’s body. There is a common misconception that binge eating disorder always involve eating in excess compared to what their bodies need. However, there are often nutritional imbalances and deficits. Therefore, properly fueling one’s body helps break binging urges. A dietitian will understand the significance of maintaining blood sugar balance, which is important as PMOS is linked with insulin resistance and having balanced meals will help reduce blood sugar spikes, prevent crashes that trigger food cravings leading to binges, as well as improving energy, mood, and hormonal balance.

Working with a psychologist and dietitian can help challenge eating disorder food rules such as severely restricting all carbohydrates including those which are essential to good health.  They can also help incorporate fear foods. It can also reduce guilt around eating, self-critism, shame and judgement. Together, this support fosters healing around food, movement, and body which allows for more flexibility and trust with oneself and one’s body.

Final Thoughts on the PCOS/PMOS & BED Connection

Remember to be kind and give yourself grace as you are navigating this journey. Your health is a significant part of your life, but it isn’t the sum of who you are. Lean on your support team and trust that you do not have to do this alone. You got this!

Thank you to Best Within You Therapy & Wellness psychologists and eating disorder specialists Dr. Laura Riss and Dr. Sarah Holmes, and intern Kelsey Tran for writing and peer reviewing this blog post.