Binge eating disorder
Editor(s)-in-Chief: C. Michael Gibson, M.S.,M.D. [1] Phone:617-632-7753; Mark Warren, M.D., M.P.H.; Fellow, Academy of Eating Disorders [2]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [3]
Synonyms and keywords: BED; night eating syndrome; NES
Overview
Binge eating disorder (BED) is an eating disorder characterized by binge eating episodes during which one feels a loss of control and is noticeably distressed over their eating. BED does not present subsequent purging episodes. Though BED can occur in normal weight individuals, it often leads to obesity. 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. [1]
Historical Perspective
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.
Classification
Pathophysiology
No one knows for sure what causes binge eating disorder. As many as half of all people with binge eating disorder have been depressed in the past. Whether depression causes binge eating disorder or whether binge eating disorder causes depression is not known for sure.
Emotional cues such as anger, sadness, boredom, and anxiety can trigger binge eating. Impulsive behavior and certain other emotional problems can be more common in people with binge eating disorder. However, many people also claim that binging occurs regardless of their mood.
It is also unclear if dieting and binge eating are related. Some studies show that about half of all people with binge eating disorder had binge episodes before they started to diet.
Researchers also are looking into how brain chemicals and metabolism affect binge eating disorder, although this study is in its early stages.
Differential Diagnosis
- Bipolar and depressive disorders
- Borderline personality disorder
- Bulimia nervosa
- Compulsive overeating
- Obesity[2]
Binge eating symptoms are also present in bulimia nervosa. The formal diagnosis criteria are similar in that subjects must binge at least twice per week for a minimum period of three months.[3] Unlike in bulimia, those with BED do not purge, fast or engage in strenuous exercise after binge eating. Additionally, bulimics are typically of normal weight or slightly overweight, whereas those with binge eating disorder are typically overweight or obese.
Binge eating disorder is similar to, but it is distinct from, compulsive overeating. Those with BED do not have a compulsion to overeat and do not spend a great deal of time fantasizing about food. On the contrary, some people with binge eating disorder have very negative feelings about food. 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. Currently, the DSM-IV categorizes it under Eating disorder not otherwise specified (EDNOS), an indication that more research is needed.
Epidemiology and Demographics
Prevalence
The prevalence of binge eating disorder is 1,600-800 per 100,000 (1.6%-0.8%) of the overall population.[2]
About 2 percent of all adults in the United States (as many as 4 million Americans) have binge eating disorder. About 10 to 15 percent of people who are mildly obese and who try to lose weight on their own or through commercial weight-loss programs have binge eating disorder. The disorder is even more common in people who are severely obese.
Gender
About one in five young women report that they have had binge-eating symptoms, according to the National Institute of Mental Health. Women account for about 60% of binge-eating disorder symptoms. Three women for every two men have it.
Ethnicity
The disorder is found in all ethno-cultural and racial populations.
Risk Factors
- Genetic predisposition[2]
- Obesity
Natural History, Complications, and Prognosis
People with binge eating disorder can get sick due to a lack of proper nutrition. Binging episodes usually include foods that are high in sugar and/or salt, but low in healthier nutrients.
People with binge eating disorder are usually very upset by their binge eating and may become very depressed.
People who are obese and have binge eating disorder often became overweight at a younger age than those without the disorder. They might also lose and gain back weight more often.
People who are obese and also have binge eating disorder are at risk for type 2 diabetes, high blood pressure, high blood cholesterol levels, gallbladder disease, heart disease, and certain types of cancer.
Most people with binge eating disorder have tried to control it on their own, but have not been able to control it for very long. Some people miss work, school, or social activities to binge eat. Persons who are obese with binge eating disorder often feel bad about themselves and may avoid social gatherings.
Most people who binge eat, whether they are obese or not, feel ashamed and try to hide their problem. Often they become so good at hiding it that even close friends and family members don't know they binge eat.
Diagnosis
Diagnostic Criteria
DSM-V Diagnostic Criteria for Binge Eating Disorder[2]
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History and Symptoms
Binge eating disorder is a psychiatric disorder in which a subject shows the following symptoms.
- Periodically does not exercise control over consumption of food
- Eats an unusually large amount of food at one time -- more than a normal person would eat in the same amount of time.
- Eats much more quickly during binge episodes than during normal eating episodes
- Eats until physically uncomfortable
- Eats large amounts of food even when they are not really hungry
- Usually eats alone during binge eating episodes, in order to avoid discovery of the disorder
- Often eats alone during periods of normal eating, owing to feelings of embarrassment about food
- Feels disgusted, depressed, or guilty after binge eating
Laboratory Findings
Imaging
CT
MRI
Treatment
People with binge eating disorder, whether or not they want to lose weight, should get help from a health professional including physicians, nutritionists, psychiatrist, psychologists, or clinical social workers for their eating behavior. There are several different ways to treat binge eating disorder, including:
- Cognitive-behavioral therapy, which teaches people how to keep track of their eating and change their unhealthy eating habits. It also teaches them how to change the way they act in tough situations. Interpersonal psychotherapy helps people look at their relationships with friends and family and make changes in problem areas. Drug therapy, such as antidepressants, may be helpful for some people.
Researchers are still trying to find the treatment that is the most helpful in controlling binge eating disorder. The methods mentioned here seem to be equally helpful. For people who are overweight, a weight-loss program that also offers treatment for eating disorders might be the best choice.
People who are not overweight should avoid dieting because it sometimes makes their binge eating worse. Dieting here means skipping meals, not eating enough food each day, or avoiding certain kinds of food (such as carbohydrates or fats). Many people with binge eating disorder are obese and have health problems because of their weight. People with binge eating disorder who are obese may find it harder to stay in a weight-loss program. They also may lose less weight than other people, and may regain weight more quickly due to a slowing of the metabolism. (This can be worse when they also have problems like depression, trouble controlling their behavior, and problems dealing with other people.) These people may need treatment for binge eating disorder before they try to lose weight. Dieting is usually not successful for those with BED, as they will usually gain back all of the weight lost, and sometimes more. Those with BED have more difficulty adhering to traditional weight-loss treatment.[4]
Medical Therapy
Psychotherapy
Brain Stimulation Therapy
Future and Investigational Therapies
A small (40 people) 10 week double-blind clinical trial was reported in the Journal of Clinical Psychiatry on the effectiveness of Atomoxetine (a prescription ADHD medicine) for treating Binge-Eating Disorder. The results of the trial was that Atomoxetine was "associated with a significantly greater rate of reduction in binge-eating episode frequency, weight, [and] body mass index." The average daily dose given was 106 mg/day. The authors conclude that Atomoxetine is effective for short term treatment of Binge-Eating Disorder [5].
References
- ↑ Kessler RC, Berglund P, Chiu WT, Demler O, Heeringa S, Hiripi E; et al. (2004). "The US National Comorbidity Survey Replication (NCS-R): design and field procedures". Int J Methods Psychiatr Res. 13 (2): 69–92. PMID 15297905.
- ↑ 2.0 2.1 2.2 2.3 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
- ↑ United States Department of Health and Human Services - Substance Abuse and Mental Health Services Administration (2007-07-10). "Eating Disorders". Retrieved 2007-07-10.
- ↑ Kriz, Kerri-Lynn Murphy (2002). The Efficacy of Overeaters Anonymous in Fostering Abstinence in Binge-Easting Disorder and Bulimia Nervosa. Virginia Polytechnic Institute and State University. Unknown parameter
|month=ignored (help) - ↑ Elroy, Susan (2007). "Atomoxetine in the Treatment of Binge-Eating Disorder: A Randomized Placebo-Controlled Trial" (PDF). Journal of Clinical Psychiatry. 68 (3): 390–398.