By: Khomotso Fredah Matlala
Photo Credit: The Defeating Epilepsy Foundation
Beyond Seizures and Symptoms: Exploring the Relationship Between Binge Eating Disorder and Epilepsy
Introduction:
When people think about epilepsy, they often think about seizures. Far less attention is paid to the emotional and behavioural challenges that can accompany a chronic neurological condition. Emerging research suggests that for some individuals, epilepsy and binge eating disorder may intersect in complex ways that affect both physical health and psychological wellbeing.
Traditional medical models typically treat epilepsy and Binge Eating Disorder (BED) as two unrelated conditions. However, research suggests that clinicians must look beyond simple seizure control to address the broader behavioural and cognitive needs of patients (Marini et al., 2026). There is evidence of bidirectional relationships between psychiatric disorders and epilepsy, where seizures may increase vulnerability to behavioural issues and pre-existing psychiatric conditions may increase the risk of developing epilepsy (Aycan et al., 2026).
Adolescents with epilepsy have been reported to have a higher prevalence of eating disorders. Estimated to be approximately 7% higher than that found in the general population (Keshen et al., 2022). Onset typically occurs roughly a year and half after the initial epilepsy diagnosis (Keshen et al., 2022). However, the link between epilepsy and mental health or behavioural problems is not a simple, one-way reaction. This suggests that instead of seizures directly causing behavioural issues, researchers are discovering that both conditions likely share a deeper, underlying root cause in the brain (Aycan et al., 2026).
The Lived Experience: Control and Autonomy:
The unpredictability of seizures often leads to a profound loss of physical autonomy.
As I discussed in my previous article on the erosion of agency in people living with epilepsy, this unpredictability constantly strips away a person’s sense of agency and control over their own life. This lack of control over one’s body is a core feature shared by BED, which is characterised by a “loss of control” during eating episodes (Keshen et al., 2022). For some patients, binging may serve as a maladaptive way to regain a sense of agency in a life disrupted by unpredictable neurological events (Aycan et al., 2026). Furthermore, what appears to be psychological dissociation or “memory lapses” during a binge can sometimes be actual epileptic activity, such as absence seizures, which can trigger impulsive and unrestrained eating behaviours (Marini et al., 2026). Both conditions are also linked by heavy social stigma and shame, which often prevents patients from seeking the necessary help (Keshen et al., 2022).
Shared Neurobiological and Hormonal Mechanisms:
Neurobiological research identifies commonalities in the reward systems of the brain. BED is often associated with a low dopaminergic state and hyperreactivity to food cues in reward-related neural circuits (Keshen et al., 2022). Similarly, chronic seizures can cause functional changes in corticostriatal circuits, which are responsible for regulating motivation and impulse control. Stress also plays a role; the ongoing burden of managing a chronic illness like epilepsy can elevate cortisol and trigger an emotional regulation loop, where binging provides temporary relief from anxiety (Keshen et al., 2022; Tokatly Latzer et al., 2023). Additionally, certain anti-seizure medications (ASMs) may influence appetite. For example, valproic acid is frequently linked to weight gain and increased appetite, whereas medications like topiramate may induce weight loss (Aycan et al., 2026; Tokatly Latzer et al., 2023).
Emotional Regulation and the Trauma of Chronic Illness:
For some individuals, recurrent seizures, hospitalizations, and the uncertainty associated with epilepsy can contribute to chronic anxiety and, in certain cases, symptoms consistent with post-traumatic stress. (Tokatly Latzer et al., 2023; Marini et al., 2026). Adolescents with both epilepsy and an eating disorder experience significantly higher rates of depression, anxiety and suicidal thoughts compared to those with only one of these conditions (Tokatly Latzer et al., 2023). Binging may function as a tool for emotional regulation, allowing a patient to numb the overwhelming fears or dissociate from the constant threat of the next seizure (Marini et al., 2026). This disconnection from the body can lead to “interoceptive blindness,” where patients struggle to read internal signals of hunger and fullness. A key predictor of binge behaviour in these populations is “perseveration,” the compulsive tendency to continue a behaviour even when it is no longer functional (Marini et al., 2026).
The Double Burden of Stigma:
Individuals living with both epilepsy and binge eating disorder often face a unique social challenge: the stigma associated with both conditions. Despite increased public awareness, epilepsy remains widely misunderstood. Misconceptions about seizures may lead to social exclusion, discrimination, or fear from others (Yeni, 2023). Similarly, binge eating disorder is frequently mischaracterised as a lack of self-control rather than a complex mental health condition (Ainz-Galende et al., 2025).
As a result, individuals may experience shame from multiple directions. They may fear disclosing their epilepsy because of concerns about how others will react, while simultaneously hiding their struggles with eating because of embarrassment or fear of judgement. This double stigma can increase social isolation and make it more difficult to seek help (Tokatly Latzer et al., 2023; Keshen et al., 2022).
For adolescents, who are already navigating identity development and peer relationships, these experiences can be particularly distressing. Feeling misunderstood or judged may reinforce emotional distress and contribute to maladaptive coping strategies, including binge eating behaviours (Nagata et al., 2024). Addressing stigma is therefore not simply a matter of public education; it is an important component of prevention, early intervention, and psychological wellbeing.
Integrative Treatment Approach:
Effective treatment requires a multidisciplinary approach that reconnects patients with their bodily signals. Cognitive Remediation Therapy (CRT) and mindfulness can improve inhibitory control and cognitive flexibility (Giel et al., 2022). Evidence-based psychological interventions such as Cognitive Behavioural Therapy (CBT), Interpersonal Psychotherapy (IPT), and Dialectical Behavioural Therapy (DBT) are highly effective for managing the emotional dysregulation associated with BED (Grilo et al. 2024). In specific cases, pharmacological treatments like lamotrigine have been shown to stop binging episodes that were directly triggered by seizure activity (Marini et al., 2026). Unified care teams consisting of neurologists, mental health professionals, and dietitians are essential to provide comprehensive, trauma-informed care that addresses both the physical and emotional aspects of these comorbid conditions (Keshen et al., 2022).
Conclusion
When clinicians recognise the intersection between neurological and psychological health, they create opportunities for earlier intervention, more compassionate care, and better long-term outcomes. Understanding the relationship between epilepsy and binge eating disorder is not simply about identifying comorbidity; it is about seeing the whole person behind the diagnosis. (Aycan et al., 2026; Marini et al., 2026). Routine screening for eating pathologies in epilepsy clinics is vital for early intervention (Tokatly Latzer et al., 2023). By implementing integrated, compassionate care models, healthcare providers can significantly improve the safety and quality of life for the epilepsy community (Keshen et al., 2022).
References
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