Binge eating disorder

Binge eating disorder (BED) is the most common eating disorder in the United
States affecting 3.5% of females and 2% of males and is prevalent in up to 30% of those
seeking weight loss treatment. Although it is not yet classified as a separate eating
disorder, it 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 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 for
those with subclinical BED, 63.6%

Signs

• Periodically does not exercise control over consumption of food.

• Eats an unusually large amount of food at one time, far 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 and nauseated due to the amount of food just
consumed.
• Eats when depressed or bored.
• Eats large amounts of food even when 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.
• Rapid weight gain, and/or sudden onset of obesity.

Relationship to other eating disorders

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 for bulimia nervosa and a minimum of 6 months for BED. 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, are underweight but have
been overweight before, or are slightly overweight. Those with binge eating disorder are
more likely to be overweight or obese.
Binge eating disorder is similar to, but 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.

Occurrence and risk factors

Most people with this problem are either overweight or obese, but people of normal
weight can also have the disorder.

About two percent of all adults in the United States (as many as four million Americans)
have binge eating disorder. About ten to fifteen 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.

Binge eating disorder is twice as common among women as among men. The disorder is
found in all ethno-cultural and racial populations. 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, or be paranoid about
gaining weight.

Causes

No one knows for sure what causes binge eating disorder. Many as half of all people with
binge eating disorder have been depressed in the past. Whether depression causes binge
eating disorder, whether binge eating disorder causes depression, or whether the two have
a common cause, is not known for sure.

The trigger point can be emotion such as happiness, anger, sadness or boredom.
Impulsive behavior and certain other emotional problems can be more common in people
with binge eating disorder. However, many people also claim that bingeing occurs
regardless of their mood. It is also unclear whether 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 say that binge eating disorder is more common among competitive
athletes such as swimmers or gymnasts whose body form is regularly on public display.
Affected athletes in these sports tend to compare their own bodies in a negative way with
those of their teammates. There is a research into how brain chemicals and metabolism
affect binge eating disorder, but this study is in its early stages.
Complications

While people tend to overeat from time to time, a consistent habit of frequent
consumption of large amounts of food in a short period of time usually leads to weight
gain and obesity. The most problematic health consequences of this type of eating
disorder are brought on by the weight gain resulting from the bingeing episodes.

People with binge eating disorder may become ill due to a lack of proper nutrition.
Bingeing episodes usually include foods that are high in fat, sugar, and/or salt, but low in
vitamins and minerals. Individuals are usually very upset about their binge eating and
may become depressed. Those who are obese and also have binge eating disorder are at
risk for type 2 diabetes, high blood pressure (hypertension), high blood cholesterol levels
(hypercholesterolemia), 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. Obese people with binge eating disorder often feel bad about themselves and
may avoid social gatherings. Those who binge eat, whether obese or not, feel ashamed,
are well aware of their disordered eating patterns, and try to hide their problems. Often
they become so good at hiding it that even close friends and family members are unaware
that they binge eat. Some of the most common symptoms are:

• Eating large amounts of food, even when not physically hungry. Eating more
rapidly than usual.
• Eating until uncomfortably full.
• Eating alone out of embarrassment at the quantity of food being eaten.
• Feelings of disgust, depression, or guilt after eating.

Dieting

People who are not overweight should avoid dieting because it sometimes makes their
binge eating worse. Dieting here means skipping meals, not eating enough calories 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.
Treatment

People with binge eating disorder, whether or not they want to lose weight, should seek
help from health professionals including physicians, nutritionists, psychiatrists,
psychologists, clinical social workers or by attending 12-step Overeaters Anonymous
meetings. Even those who are not overweight are usually upset by their binge eating, and
treatment can help them.

Although mental health professionals may be attuned to the signs of binge eating
disorders, most physicians do not raise the question, either because they are uninformed
about the condition or too embarrassed to ask about it. Because it is not a recognized
psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders, it is
difficult to obtain insurance reimbursement for treatments.

There are several different ways to treat binge eating disorder. Cognitive-behavioral
therapy 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 to improve health and to build self-
esteem, as well as counselling to pinpoint the root of the psychological problems
triggering their binge episodes, might be the best choice.

A clinical trial in Helsinki is investigating the use of intra-nasal naloxone for binge eating
disorder, using the same approach as the highly successful Sinclair Method for alcohol
addiction. Results of this trial are expected 2011.

References

1. Hudson et. al.The prevalence and correlates of eating disorders in the National
Comorbidity Survey Replication. Biological Psychiatry.2007 Feb 1;61(3)348-58
PMID 16815322
2. Cooper Z, Fairburn CG.Refining the definition of binge eating disorder and
nonpurging bulimia nervosa.Int J Eat Disord. 2003;34 Suppl:S89-95.PMID
12900989
3. Hudson JI. Binge-eating disorder as a distinct familial phenotype in obese
individuals. Arch Gen Psychiatry. 2006 Mar;63(3):313-9.PMID 16520437