Binge eating disorder
Binge eating disorder is an eating disorder characterized by frequent and recurrent binge eating episodes with associated negative psychological and social problems, but without the compensatory behaviors common to bulimia nervosa, OSFED, or the binge-purge subtype of anorexia nervosa.
BED is a recently described condition, which was introduced to distinguish binge eating similar to that seen in bulimia nervosa but without characteristic purging. Individuals who are diagnosed with bulimia nervosa or binge eating disorder exhibit similar patterns of compulsive overeating, neurobiological features such as dysfunctional cognitive control and food addiction, and biological and environmental risk factors. Some professionals consider BED to be a milder form of bulimia, with the two conditions on the same spectrum.
Binge eating is one of the most prevalent eating disorders among adults, though it receives less media coverage and research about the disorder compared to anorexia nervosa and bulimia nervosa.
Signs and symptoms
Binge eating is the core symptom of BED; however, not everyone who binge eats meets qualifications for BED. An individual may occasionally binge eat without experiencing many of the negative physical, psychological, or social effects of BED. This may be considered disordered eating rather than a clinical disorder. Precisely defining binge eating can be problematic; however, binge eating episodes in BED are generally described as having the following potential features:- Eating much faster than normal, perhaps in a short space of time
- Eating until feeling uncomfortably full
- Eating a large amount even when not hungry
- Subjective loss of control over how much or what is eaten
- Planning and allocating specific times for bingeing
- Eating alone or secretly
- Not being able to remember what was eaten after the binge
- Feelings of guilt, shame, or disgust following a food binge
- Body image disturbance
Obesity is common in persons with BED, as are depression, low self-esteem, stress and boredom. Regarding cognitive abilities, individuals showing severe binge eating symptoms may experience small dysfunctions in executive functions. Those with BED are also at risk of non-alcoholic fatty liver disease, menstrual irregularities such as amenorrhea, and gastrointestinal problems such as acid reflux and heartburn.
Causes
As with other eating disorders, binge eating is considered an "expressive disorder"—a disorder that is an expression of deeper psychological problems. People who have binge eating disorder have been found to have higher weight bias internalization, which is characterized by low self-esteem, unhealthy eating patterns, and body dissatisfaction. Binge eating disorder commonly develops as a result of or side effect of depression, as it is common for people to turn to comfort foods when they are feeling down.There was resistance to granting binge eating disorder the status of a fully fledged eating disorder because many perceived binge eating disorder to be caused by individual choices. 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. 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 involves the consumption of a large amount of food in a relatively short period of time.
Some studies show that BED aggregates in families and could be genetic. However, very few published studies of the genetics of BED exist.
Research suggests that environmental factors and the impact of traumatic events can cause binge eating disorder. One study showed that women with binge eating disorder experienced more adverse life events in the year before the onset of the disorder, and that binge eating disorder was positively associated with how frequently negative events occurred. 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 systematic review concluded that bulimia nervosa and binge eating disorder are impacted by family separations, losses and big life changes, and negative parent-child interactions 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. 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.
"In the U.S, it is estimated that 3.5% of young women and 30% to 40% of people who seek weight loss treatments can be clinically diagnosed with binge eating disorder."
Diagnosis
International Classification of Diseases
The 2017 update to the American version of the ICD-10 includes binge eating disorder under F50.81. ICD-11 contain a dedicated entry, defining BED as frequent, recurrent episodes of binge eating occurring at least once a week or more over several months which are not regularly followed by inappropriate compensatory behaviors aimed at preventing weight gain.According to the World Health Organization's ICD-11 classification of BED, the severity of the disorder can be classified as mild, moderate, severe and extreme.
Diagnostic and Statistical Manual
Initially considered a subject for further research exploration, binge eating disorder was first included in the Diagnostic and Statistical Manual of Mental Disorders in 1994, proposed a feature of an eating disorder. In 2013, it gained formal recognition as a psychiatric condition in the DSM-5. 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. Before DSM-5, Eating Disorder Not Otherwise Specified, which included BED, was diagnosed more often than both anorexia nervosa and bulimia nervosa. Because it was not a recognized psychiatric disorder in the DSM 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.One study found that the method for diagnosing BED is for a clinician who typically diagnose using the DSM-5 criteria or taking the Eating Disorder Examination. The Structured Clinical Interview for DSM takes no more than 75 minutes to complete and has a systematic approach which follows the DSM-5 criteria. The Eating Disorder Examination is a semi-structured interview that identifies the frequency of binges and associated eating disorder features.
The DSM-5 characterizes diagnosis under several categories—mild, moderate, severe, and extreme—each determined by the number of binges the patient exhibits per week.
Mild: 1-3 episodes per week, Moderate: 4-7 episodes per week, Severe: 8-13 episodes per week, Extreme: 14 or more episodes per week
Further, the remission states are classified under the following.
Partial Remission: Following a previous diagnosis, the average frequency of binge eating episodes decreases to less than one episode per week for a sustained period.
Full Remission: Following a previous diagnosis, none of the criteria have been met for a sustained period.
Management
Counseling and some medication, such as certain stimulants, selective serotonin reuptake inhibitors, and GLP-1 receptor agonists, may help people with a binge eating disorder. Some recommend a multidisciplinary approach in the treatment of the disorder.Medication
Lisdexamfetamine
As of July 2024, lisdexamfetamine is the only pharmacotherapy approved by the USFDA and TGA for BED Evidence indicates that its effectiveness in treating BED may be partially due to a psychopathological overlap with Attention deficit hyperactivity disorder, a cognitive control disorder that also benefits from treatment with lisdexamfetamine.Medical reviews of randomized controlled trials have established that lisdexamfetamine, administered at doses between 50 and 70 mg, is safe and effective for treating BED. These reviews consistently report fewer binge eating episodes during the week Furthermore, a meta-analytic systematic review included a 12-month study showing the medication was effective for a long period of time. Two reviews have found lisdexamfetamine to be superior to placebo in several secondary outcomes, including persistent binge eating cessation, reduction of obsessive-compulsive binge eating symptoms, body weight, and triglycerides.
Lisdexamfetamine is a pharmacologically inert prodrug that confers its therapeutic effects for BED after conversion to its active metabolite, dextroamphetamine, which acts in the central nervous system. Dextroamphetamine increases the activity of dopamine and norepinephrine to the prefrontal cortex, which makes major decision-making for the body. Lisdexamfetamine, like all pharmaceutical amphetamines, possesses direct appetite suppressant effects, which may be therapeutically beneficial for BED and its associated comorbidities. Neuroimaging studies involving BED-diagnosed participants suggest that long term effects in the brain that result in people getting better even after stopping their initial medication