Binge eating disorder
|Binge eating disorder|
|Classification and external resources|
Binge eating disorder (BED) is 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). The term "binge eating" was coined to describe the same binging-type eating behavior but without the exclusive nocturnal component.
Binge eating is one of the most prevalent eating disorders among adults, though there tends to be less media coverage and research about the disorder in comparison to anorexia nervosa and bulimia nervosa. Previously considered a topic for further research exploration, binge eating disorder was included in the Diagnostic and Statistical Manual of Mental Disorders in 2013.
BED is present in 0.8% of male U.S. adults and 1.6% of female U.S. adults in a given year.
Signs and symptoms
The following are DSM-5 criteria that must be present to make a diagnosis of 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 a 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 amounts 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 who binge eats 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 considered an eating problem (or not), rather than a disorder.
Before binge eating disorder received its own category in the DSM-5 in 2013, there was resistance to give binge eating disorder the status of a fully fledged eating disorder because many perceived binge eating disorder to be caused by individual choices. More research is needed to uncover the causes of binge eating disorder. Previous research has focused on the relationship between body image and eating disorders, and concludes that disordered eating might be linked to rigid dieting practices. In the majority of cases of anorexia, extreme and inflexible restriction of dietary intake leads at some point to the development of binge eating, weight regain, bulimia nervosa, or a mixed form of eating disorder not otherwise specified. 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.
However, other research suggests that binge eating disorder can also be caused by environmental factors and the impact of traumatic events. One study showed that women with binge eating disorder experienced more adverse life events in the year prior to the onset of the development of the disorder, and that binge eating disorder was positively associated with how frequently negative events occur. Additionally, the research found that individuals who had binge eating disorder were more likely to have experienced physical abuse, perceived risk of physical abuse, stress, and body criticism. Other risk factors may include childhood obesity, critical comments about weight, low self-esteem, depression, and physical or sexual abuse in childhood. A few studies have suggested that there could be a genetic component to binge eating disorder, though other studies have shown more ambiguous results. Studies have shown that binge eating tends to run in families and a twin study by Bulik, Sullivan, and Kendler has shown a, "moderate heritability for binge eating" at 41 percent. More research must be done before any firm conclusions can be drawn regarding the heritability of binge eating disorder. Studies have also shown that eating disorders such as anorexia and bulimia reduce coping abilities, which makes it more likely for those suffering to turn to binge eating as a coping strategy.
A correlation between dietary restraint and the occurrence of binge eating has been shown in some research. 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. 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 comorbidities such as major depressive disorder, personality disorder, bipolar disorder, substance abuse, body dysmorphic disorder, kleptomania, irritable bowel syndrome, fibromyalgia, or an 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). Binge eating disorder commonly develops as a result or side effect of depression, as it is common for people to turn to comfort foods when they are feeling down.
Individuals who are diagnosed with bulimia nervosa and binge eating disorder exhibit similar patterns of compulsive overeating, neurobiological features of dysfunctional cognitive control and food addiction, and biological and environmental risk factors. 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. According to the DSM-5 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. People who suffer from binge eating disorder have been found to have higher weight bias internalization, which includes low self-esteem, unhealthy eating patterns, and general body dissatisfaction.
Until 2013, binge eating disorder was categorized as an Eating Disorder Not Otherwise Specified, an umbrella category for eating disorders that don't fall under the categories for anorexia nervosa or bulimia nervosa. Because it was not a recognized psychiatric disorder in the DSM-IV until 2013, it has been difficult to obtain insurance reimbursement for treatments. The disorder now has its own category under DSM-5, which outlines the signs and symptoms 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.
Cognitive behavioral therapy (CBT) treatment has been demonstrated as a more effective form of treatment for BED than behavioral weight loss programs. 50 percent of BED individuals achieve 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. There is the 12-step Overeaters Anonymous or Food Addicts in Recovery Anonymous.
Three other classes of medications are also 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.
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.
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. 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 are often upset about their binge eating and may become depressed. BED is often associated with symptoms of depression.
Binge eating disorder is the most common eating disorder in adults, though there is generally less research on binge eating disorder in comparison to anorexia nervosa and bulimia nervosa. The lifetime prevalence of binge eating disorder has been observed in studies to be 2.0 percent for men and 3.5 percent for women, higher than that of the commonly recognized eating disorders anorexia nervosa and bulimia nervosa. Additionally, 30 to 40 percent of individuals seeking treatment for weight-loss can be diagnosed with binge eating disorder. Though the research on binge eating disorders tends to be concentrated in North America, the disorder occurs across cultures, though there is not enough research to determine whether the disorder is more prevalent in certain cultures. The limited amount of research that has been done on binge eating disorder shows that rates of binge eating disorder are fairly comparable among men and women. Rates of binge eating disorder have also been found to be similar among black women, white women, and white men, while some studies have shown that binge eating disorder is more common among black women than among white women. Still, further research is needed to fully understand the scope of the disorder.
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