Binge eating disorder
Binge eating disorder (BED) is an eating disorder characterized by binge eating without subsequent purging episodes. The disorder was first described in 1959 by psychiatrist and researcher Albert Stunkard as "night eating syndrome" (NES), and the term "binge eating disorder" was coined to describe the same binging-type eating behavior without the exclusive nocturnal component. BED usually leads to obesity although it can occur in normal weight individuals. There may be a genetic inheritance factor involved in BED independent of other obesity risks and there is also a higher incidence of psychiatric comorbidity, with the percentage of individuals with BED and an Axis I comorbid psychiatric disorder being 78.9% and 63.6% for those with subclinical BED.
Signs and symptoms
The following are DSM-5 criteria that must be present to classify a person's behavior as binge eating disorder. Studies have confirmed the high predictive value of these criteria for diagnosing BED.
“A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- Eating, in discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
- A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B. The binge-eating episodes are associated with three (or more) of the following:
- Eating much more rapidly than normal.
- Eating until feeling uncomfortably full.
- Eating large amount of food when not feeling physically hungry.
- Eating alone because of feeling embarrassed by how much one is eating.
- Feeling disgusted with oneself, depressed, or very guilty afterward.
C. Marked distress regarding binge eating is present.
D. The binge eating occurs, on average, at least once a week for 3 months.
E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa."
Binge eating is a core symptom of binge eating disorder; however, not everyone with binge eating has binge eating disorder. An individual may occasionally binge eat without experiencing many of the negative physical, psychological, or social effects of binge eating disorder. This example may be construed as an eating problem (or not) rather than a disorder.
While binge eaters are often believed to be lacking in self-control, the root of such behavior might instead be linked to rigid dieting practices. Binge eating may begin when individuals recover from an adoption of rigid eating habits. When under a strict diet that mimics the effects of starvation, the body may be preparing for a new type of behavior pattern, one that consumes a large amount of food in a relatively short period of time.
The relationship between strict dieting and later binging may explain the high numbers of people who become trapped in a cycle of dieting and weight gain, often reaching higher and higher weights after each round of dieting and binging.
Strict dieting is an important contributing factor to binge eating, although it is also a consequence of binge eating. The relationship between strict dieting and binge eating is characterized by a vicious circle. Binge eating is more likely to occur after dieting, and vice versa. Several forms of dieting include delay in eating (e.g., not eating during the day), restriction of overall calorie intake (e.g., setting calorie limit to 1,000 calories per day), and avoidance of certain types of food (e.g., “forbidden” food, such as sugar, carbohydrates, etc.). Strict and extreme dieting differs from ordinary dieting. Some evidence suggests the effectiveness of moderate calorie restriction in decreasing binge eating episodes among overweight individuals with binge eating disorder, at least in the short-term.
Individuals who have binge eating disorder commonly have other psychiatric comorbidities such as major depressive disorder, personality disorder, bipolar disorder, substance abuse, body dysmorphic disorder, kleptomania, irritable bowel syndrome, fibromyalgia, or anxiety disorder. Binge eating symptoms are also present in bulimia nervosa. The formal diagnosis criteria differ, however, in that subjects must binge at least twice per week for a minimum period of three months for bulimia nervosa and a minimum of 6 months for BED. (This has changed in the DSM-5). Unlike in bulimia, those with BED do not exhibit compensatory behaviors such as purge, fast or engaging in compensatory strenuous exercise after binge eating episodes. Additionally, bulimics are typically of normal weight, are underweight but have been overweight before, or are somewhat overweight. Those with BED are more likely to be obese.
Binge eating disorder is similar to, but distinct from, compulsive overeating. Some individuals with BED do not have a compulsion to overeat and do not spend a great deal of time fantasizing about food.[dubious ] On the contrary, some people with binge eating disorder have very negative feelings about food. This may be due to differences in the conceptualization of binge eating. The diagnosis of a binge eating disorder is restricted to individuals with “objective” episodes of binge eating. However, some assessment tools differentiate between various types of binge eating, including objective binge eating, subjective binge eating, and atypical binge eating. Individuals with “subjective” binge eating or atypical binge eating may not have a tendency to overeat in quantitative terms. One of the main differences between binge eating and overeating is the sense of loss of control. According to the diagnostic criteria, one of the core characteristics of binge eating is a sense of lack of control. Eating an unusually large amount of food without feeling loss of control may be more appropriately termed as “overeating” instead of “binge eating”. As with other eating disorders, binge eating is an "expressive disorder"—a disorder that is an expression of deeper psychological problems. Some researchers believe BED is a milder form or subset of bulimia nervosa, while others argue that it is its own distinct disorder. The DSM-IV categorizes it under Eating disorder not otherwise specified (EDNOS), an indication that more research is needed. As of 2013 and the publication of the DSM-5, binge eating disorder no longer falls under EDNOS - it has its own diagnosis as an eating disorder.
People with binge eating disorder can seek help from health professionals including physicians, nutritionists, psychiatrists, psychologists, clinical social workers or by attending 12-step Overeaters Anonymous or Food Addicts in Recovery Anonymous meetings. Even those who are not overweight are usually upset by their binge eating, and treatment can help them. Cognitive behavioral therapy (CBT) treatment has been demonstrated as a more effective form of treatment for BED than behavioral weight loss programs with 50% of BED individuals achieving complete remission from binge eating. CBT has also been shown to be an effective method to address self-image issues and psychiatric comorbidities (e.g., depression) associated with the disorder. Recent reviews have concluded that psychological interventions such as psychotherapy and behavioral interventions are more effective than pharmacological interventions for the treatment of binge eating disorder.
Although mental health professionals may be attuned to the signs of binge eating disorders, many physicians do not raise the question, often because they are uninformed about the specifics of the condition. Because it was not a recognized psychiatric disorder in the DSM-IV, it has been difficult to obtain insurance reimbursement for treatments. However, with the publication of DSM-5, BED has now been included as an eating disorder in its own right, instead of as part of the EDNOS category as in the DSM-IV.
Bariatric surgery has also been proposed as another approach to treat BED and a recent meta-analysis showed that approximately two-thirds of individuals who seek this type of surgery for weight loss purposes have BED. Bariatric surgery recipients who had BED prior to receiving the surgery tend to have poorer weight-loss outcomes and are more likely to continue to exhibit eating behaviors characteristic of BED.
Three classes of medications are typically used in the treatment of binge eating disorder: antidepressants, anticonvulsants, and anti-obesity medications. Antidepressant medications of the selective serotonin reuptake inhibitor (SSRI) class such as fluoxetine, fluvoxamine, or sertraline have been found to effectively reduce episodes of binge eating and reduce weight. Similarly, anticonvulsant medications such as topiramate and zonisamide may be able to effectively suppress appetite. The long-term effectiveness of medication for binge eating disorder is currently unknown.
Trials of antidepressants, anticonvulsants, and anti-obesity medications suggest that these medications are superior to placebo in reducing binge eating. Medications are not considered the treatment of choice because psychotherapeutic approaches, such as CBT, are more effective than medications for binge eating disorder. Medications also do not increase the effectiveness of psychotherapy, though some patients may benefit from anticonvulsant and anti-obesity medications for weight loss.
While people of a healthy weight may overeat occasionally, an ongoing habit of consuming large amounts of food in a short period of time ultimately leads to weight gain and obesity. The main health consequences of this type of eating disorder are brought on by the weight gain resulting from the binging episodes.
People with binge eating disorder may become ill due to a lack of proper nutrition. Binging episodes usually include foods that are high in fat, sugar, and/or salt, but low in vitamins and minerals. Individuals are often upset about their binge eating and may become depressed. Those who are obese and also have BED are at risk for common comorbidities associated with obesity such as type 2 diabetes mellitus, cardiovascular disease (e.g., high blood pressure and heart disease), gastrointestinal issues (e.g., gallbladder disease), high cholesterol levels, musculoskeletal problems and obstructive sleep apnea.
Individuals suffering from BED often have a lower overall quality of life and commonly experience social difficulties. Most people with binge eating disorder have tried to control it on their own, but have not been able to for an extended period of time.
Binge eating disorder is the most common eating disorder in adults. The lifetime prevalence of binge eating disorder has been observed in studies to be 2.0% for men and 3.5% for women, higher than that of the commonly recognized eating disorders anorexia nervosa and bulimia nervosa. The disorder is also associated with the development of severe obesity.
The disorder is found in all cultures and ethnicities. People who are obese and have binge eating disorder often became overweight at an earlier age than those without the disorder. They might also lose and gain back weight more often, or be hypervigilant about gaining weight.
Other risk factors may include childhood obesity, critical comments about weight, low self-esteem, depression, and physical or sexual abuse in childhood. A study in behavior genetics has also suggested that binge eating disorder may have a genetic component. It has been found that 20% of relatives of obese individuals with binge eating disorder also have binge eating disorder, compared to 9% of relatives of obese individuals without binge eating disorder.
- Hudson, JI; Hiripi, E; Pope Jr, HG; Kessler, RC (2007). "The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication". Biological Psychiatry 61 (3): 348–58. doi:10.1016/j.biopsych.2006.03.040. PMC 1892232. PMID 16815322.
- Cooper, Z; Fairburn, CG (2003). "Refining the definition of binge eating disorder and nonpurging bulimia nervosa". The International Journal of Eating Disorders. 34 Suppl: S89–95. doi:10.1002/eat.10208. PMID 12900989.
- Hudson, JI; Lalonde, JK; Berry, JM; Pindyck, LJ; Bulik, CM; Crow, SJ; McElroy, SL; Laird, NM et al. (2006). "Binge-eating disorder as a distinct familial phenotype in obese individuals". Archives of General Psychiatry 63 (3): 313–9. doi:10.1001/archpsyc.63.3.313. PMID 16520437.
- De Zwaan, M; Friederich, HC (2006). "Binge eating disorder". Therapeutische Umschau. Revue therapeutique 63 (8): 529–33. doi:10.1024/0040-5922.214.171.1249. PMID 16941397.
- Westerburg DP, Waitz M (November–December 2013). "Binge-eating disorder". Osteopathic Family Physician 5 (6): 230–33. doi:10.1016/j.osfp.2013.06.003.
- Association], [American Psychiatry (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed. ed.). Washington [etc.]: American Psychiatric Publishing. p. 350. ISBN 0890425558.
- Fairburn, Christopher (2013). Overcoming binge eating: the proven program to learn why you binge and how you can stop (Second Edition. ed.). New York: Guilford Publications. ISBN 1572305614.
- Reinhard J. Tuschl, 1989. "From dietary restraint to binge eating: Some theoretical considerations". Volume 14, Issue 2, April 1990, Pages 105–109 http://www.sciencedirect.com/science/article/pii/019566639090004R
- "Why Extreme Dieting Sometimes Leads To Eating Disorder Treatment" http://www.casapalmera.com/articles/relationship-between-dieting-and-eating-disorders/
- 07/05/2011. "Binge Eating may be Caused by Rigidity in Dieting" http://www.treatmentcenters.net/eating-disorders/binge-eating-caused-by-rigid-dieting/
- Wilson, Terence (2002). "The controversy over dieting". In Fairburn, Christopher; Brownell, Kelly. Eating disorders and obesity: a comprehensive handbook (2nd ed.). New York: Guilford. ISBN 1593852363.
- Wilfley, Denise (2002). "Psychological treatment of binge eating disorder". In Fairburn, Christopher; Brownell, Kelly. Eating disorders and obesity: a comprehensive handbook (2nd ed.). New York: Guilford. ISBN 1593852363.
- Marazziti D, Corsi M, Baroni S, Consoli G, Catena-Dell'Osso M (December 2012). "Latest advancements in the pharmacological treatment of binge eating disorder". Eur Rev Med Pharmacol Sci 16 (15): 2102–7. PMID 23280026.
- United States Department of Health and Human Services - Substance Abuse and Mental Health Services Administration (2007-07-10). "Eating Disorders". Retrieved 2007-07-10.
- Iacovino JM, Gredysa DM, Altman M, Wilfley DE. (August 2012). "Psychological treatments for binge eating disorder". Curr Psychiatry Rep 14 (4): 432–46. doi:10.1007/s11920-012-0277-8. PMC 3433807. PMID 22707016.
- Mitchell, James; Devlin, Michael; de Zwaan, Martina; Crow, Scott; Peterson, Carol (2008). "Diagnosis and epidemiology of binge-eating disorder". Binge-eating disorder: clinical foundations and treatment (1. edition. ed.). New York: Guilford Press. ISBN 978-1593855949.
- Binge Eating Disorder: Surprisingly Common, Seriously Under-treated . Psychiatric Times, April 3, 2007.
- "A Guide to DSM-5: Binge Eating Disorder". Medscape.com. Retrieved 2013-06-08.
- Lindsay Bodell; Micheal Devlin (2011). "Pharmacotherapy for binge-eating disorder". In Grilo, Carlos; Mitchell, James. The treatment of eating disorders: a clinical handbook. New York: Guilford. ISBN 978-1609184957.
- "Binge Eating Disorder". National Eating Disorders Association. Retrieved 18 April 2014.
- Fairburn et. al, 1998. "The classification of recurrent overeating: the "binge eating disorder" proposal". International Journal of Eating Disorders 13: 155-159 http://onlinelibrary.wiley.com/doi/10.1002/1098-108X(199303)13:2%3C155::AID-EAT2260130203%3E3.0.CO;2-T/abstract
- Fairburn, C.G. (1995). Overcoming Binge Eating. New York: Guilford Press, ISBN 0-89862-961-6.
- Grilo, C.M. (1998). "The Assessment and Treatment of Binge Eating Disorder". Journal of Practical Psychiatry and Behavioral Health 4: 191–201.
- Siegel, M.; Brisman, J.; & Weinshel, M. (1988). Surviving an Eating Disorder: New Perspectives and Strategies for Family and Friends. New York: Harper & Row, ISBN 0-06-015859-X.
- Stunkard, A.J. (1959). "Eating Patterns and Obesity". Psychiatric Quarterly 33 (2): 284–295. doi:10.1007/BF01575455. PMID 13835451.
- Yanovski, S.Z. (1993). "Binge Eating Disorder: Current Knowledge and Future Directions". Obesity Research 1 (4): 306–323.
- Binge Eating Disorder at Medline Article
- National Institute of Health page on binge eating disorder
- National Eating Disorder Information Centre
- Binge Eating Disorder Association