Byline: Anna I. Guerdjikova, PhD, LISW
Binge eating disorder (BED) is an eating disorder characterized by binge eating without subsequent purging episodes. Individuals with BED consume large amounts of food in a short period of time while feeling out of control and powerless to stop the overeating. BED patients often struggle with feelings of guilt, disgust, and depression related to their abnormal eating behavior.
BED is the most common eating disorder in adults. The lifetime prevalence of BED has been estimated 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. Of note, BED is found in all cultures and ethnicities and spans from childhood to old age.
Since May 2014, the updated version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) formally recognized BED as a distinct eating disorder, separate from the general Eating Disorder, Not Otherwise Specified category where BED was categorized. In order to receive the diagnosis of BED, an individual must meet the DSM-5diagnostic criteria listed below: experiencing recurring episodes of binge eating (consuming an abnormally large amount of food in a short period of time) and experiencing a lack of control over eating during the episode. Binge eating episodes must also exhibit at least 3 of the following characteristics: consuming food faster than normal; consuming food until uncomfortably full; consuming large amounts of food when not hungry; consuming food alone due to embarrassment; and feeling disgusted, depressed, or guilty after binging. A binging episode needs to occur at least once weekly for 3 months for formal diagnosis.
An example of a binge episode might be: an individual would eat a bowl of cereal with milk, 2 scoops of ice cream, ½ bag of chips and a sleeve of cookies in a two hour period, shortly after a full size dinner; or a person driving through a fast food restaurant after work, consuming a whole meal there, and then going home to eat a regular dinner with family. Of note, the binge eating episode must be accompanied by sense of lack of control and distress in order to meet DSM-5 diagnostic criteria for BED.
While etiology of BED is not fully understood, it is believed that dysregulation in dopamine, serotonin and glutamate neurotransmitter systems might contribute to BED development. Furthermore, there may be a genetic inheritance factor involved in BED. Risk factors for BED development may also include repetitive yo-yo dieting, childhood obesity, critical comments about weight, low self-esteem, depression, and physical or sexual abuse in childhood.
Individuals with BED commonly have other psychiatric comorbidities such as mood disorders (major depressive disorder or bipolar disorder) and anxiety disorders. Binge eating is also a core symptom of bulimia nervosa. Unlike in bulimia, however, individuals with BED do not exhibit compensatory behaviors such as purging, fasting or engaging in compensatory excessive exercise after binge eating episodes.
Individuals suffering from BED often have a lower overall quality of life and commonly experience social difficulties. BED is often associated with increased medical morbidity. Up to 80% of individuals with BED are overweight or obese and are at risk of suffering from obesity related complications like metabolic syndrome, increased risk for cardiovascular diseases, gastrointestinal problems and cancer.
Successful treatment of BED begins with proper and thorough diagnosis. Binge eating is a shameful behavior and most of the time patients do not disclose it readily. Focusing their attention on specific examples like excessive, repetitive snacking or sneaking food or eating way beyond the point of comfort regularly might help with self-disclosure.
If BED is diagnosed, a plethora of psychological and pharmacological options for its treatment are available. BED care is best implemented by a professional team consisting of a psychiatrist, a psychologist and a dietician. Cognitive behavior therapy (CBT) is currently considered the gold standard in the treatment for BED. Dialectical Behavior therapy techniques as well as guided self-help might also be helpful. While no medication is currently approved in the treatment of BED, certain antidepressants, antiepileptic and Attention Deficit Hyperactivity Disorder (ADHD) drugs hold promise in controlling BED. For example, Vyvanse (lisdexamfetamine dimesylatelate; approved for ADHD in the US) was recently announced to be effective in significantly decreasing binge days per week as compared to placebo in two pivotal Phase 3, multi-center, randomized studies.
BED is a biological illness and an important public health problem that is under-recognized. Timely diagnosis and comprehensive treatment are important in BED management, possibly decreasing long term consequences of dysregulated eating behavior and associated weight gain.