Binge Eating Disorder

Binge eating disorder is an eating disorder marked by recurrent episodes of binge eating without inappropriate compensatory behavior. Episodes occur at least weekly for 3 consecutive months. There is a loss of control during the episodes of binging as well as distress after. Treatment consists of a combination of psychotherapy and pharmacotherapy.

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Overview

Definition

Binge eating disorder is a psychiatric ailment classified as an eating disorder in which the patient has recurrent episodes of binge eating without inappropriate compensatory behavior.

Binge eating is defined as consuming an amount of food in a specified amount of time (e.g., 1 hour) that greatly exceeds what most people would consume in that same amount of time.

Epidemiology

  • Lifetime prevalence is 2%–3%.
  • Women are affected more than men.
  • No difference in prevalence among racial or ethnic groups 
  • High prevalence among those with severe obesity (BMI > 40) but still occurs in those with normal weight 
  • Increased risk of developing comorbid general medical condition, including chronic pain, diabetes, and hypertension

Comorbidities

  • Specific phobias
  • Social phobias
  • Depression
  • PTSD
  • Alcohol abuse or substance dependence

Diagnosis

Difficult to diagnose:

  • Patients often feel ashamed and reluctant to seek help.
  • Clues include:
    • Greater-than-expected weight dissatisfaction
    • Fluctuating weight 
    • Depressive symptoms
  • Might have significant negative impact on physical health and/or psychosocial functioning

Initial intake must include:

  • Signs of abuse (physical or sexual) 
  • Presence of comorbidities associated with obesity, including but not limited to hypertension, diabetes, GERD, obstructive sleep apnea (OSA), and hypothyroidism

Subsequent visits must monitor:

  • Blood pressure
  • Blood glucose (BG)
  • Nutritional and exercise status

Diagnostic criteria:

  • Recurrent episodes of binge eating with lack of control, marked by criteria such as:
    • Eating more rapidly than normal
    • Eating until feeling uncomfortably full
    • Eating large amounts of food when not hungry
    • Eating alone due to embarrassment 
    • Feeling disgusted with oneself, depressed, or guilty after overeating
  • No regular use of inappropriate compensatory behaviors (e.g., purging, fasting, or excessive exercise) as seen in bulimia nervosa
  • Episodes occur at least 1/week for 3 months.

Management

It is important to address other psychiatric issues (depression, anxiety, low self-esteem) and comorbidities (obesity, hypertension, etc.), too.

Psychotherapy

  • CBT:
    • 1st-line treatment 
    • Has better results than medications alone (no difference when combining CBT with medications)
    • Rapid improvement in binge eating symptoms is associated with good prognosis.
  • Interpersonal psychotherapy: useful in long-term treatment by addressing root causes 
  • Group therapy: Overeaters Anonymous provides group support similar to other anonymous support groups that treat addiction.
  • Lifestyle modification: 
    • Many of those who meet criteria seek weight-reduction treatment instead. 
    • Low-calorie diet and consistent exercise are best for long-term management. 
    • Nutritional consult may be beneficial in extreme cases.

Pharmacotherapy

  • Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) (e.g., fluvoxamine, citalopram, sertraline) help with mood and binge eating symptoms.
  • Mood stabilizers, such as topiramate, have demonstrated efficacy.
  • Stimulants suppress appetite but have little impact over the long term.

Differential Diagnosis

  • Anorexia nervosa: eating disorder characterized by intense fear of gaining weight, restricted dietary habits, and distorted body image. Patients affected by anorexia nervosa are usually underweight and reluctant to seek medical help. Treatment involves CBT with antidepressant medication as an adjunct. Extreme cases may require hospitalization.
  • Bulimia nervosa: anxiety-driven eating disorder defined by recurrent episodic binge eating paired with recurrent inappropriate compensatory behavior (e.g., inducing vomiting, laxative abuse, excessive exercising). Patients with bulimia nervosa may have normal or even elevated BMI and are more likely to seek help. Treatment involves a combination of CBT and SSRI medication.
  • Obesity: condition associated with elevated body weight, specifically with excessive adipose tissue deposition. Diagnosis is most commonly made with BMI measurement, with obesity defined as BMI > 30. Binge eating disorder is a diagnosis frequently found in those with obesity and, thus, physicians should screen for binge eating habits in obese patients. Those with binge eating disorder and obesity have a higher prevalence of comorbid psychiatric disorders, as well as more severe eating-disorder pathology. 

References

  1. Kessler, RC, Berglund, PA, Chiu, WT, Deitz, AC, Hudson, JI, Shahly, V, Aguilar-Gaxiola, S, Alonso, J, Angermeyer, MC, Benjet, C, Bruffaerts, R, de Girolamo, G, de Graaf, R, Maria Haro, J, Kovess-Masfety, V, O’Neill, S, Posada-Villa, J, Sasu, C, Scott, K, Viana, MC, & Xavier, M. (2013). The prevalence and correlates of binge eating disorder in the World Health Organization World Mental Health Surveys. Biol Psychiatry. Pages 904–14. https://pubmed.ncbi.nlm.nih.gov/23290497/ 
  2. Hudson, JI, Hiripi, E, Pope Jr., HG, & Kessler, RC. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. https://pubmed.ncbi.nlm.nih.gov/16815322/ 
  3. Devlin, MJ, Goldfein, JA, Petkova, E, Jiang, H, Raizman, PS, Wolk, S, Mayer, L, Carino, J, Bellace, D, Kamenetz, C, Dobrow, I, & Walsh, BT. (2005). Cognitive behavioral therapy and fluoxetine as adjuncts to group behavioral therapy for binge eating disorder. Obes Res. https://pubmed.ncbi.nlm.nih.gov/15976151/ 
  4. Sadock, BJ, Sadock, VA, & Ruiz, P. (2014). Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Chapter 15, Feeding and Eating Disorders, pages 509-532. Philadelphia, PA: Lippincott Williams and Wilkins.
  5. Westmoreland, P. (2017). Feeding and eating disorders. doi:10.2310/im.13038
  6. Westmoreland, P. (2018). Clinical management of feeding and eating disorders. doi:10.2310/im.13039

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