178 Binge-Eating Disorder

DSM-IV-TR criteria

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

• (1) eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
• (2) a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)

B. The binge-eating episodes are associated with three (or more) of the following:

• (1) eating much more rapidly than normal
• (2) eating until feeling uncomfortably full
• (3) eating large amounts of food when not feeling physically hungry
• (4) eating alone because of being embarrassed by how much one is eating
• (5) feeling disgusted with oneself, depressed, or very guilty after overeating
• C. Marked distress regarding binge eating is present.

D. The binge eating occurs, on average, at least 2 days a week for 6 months.

• Note: The method of determining frequency differs from that used for Bulimia Nervosa; future research should address whether the preferred method of setting a frequency threshold is counting the number of days on which binge eating occur or counting the number of episodes of binge eating.

E. The binge eating is not associated with the regular use of inappropriate compensatory behaviors (e.g., purging, fasting, excessive exercise) and does not occur exclusively during the course of Anorexia Nervosa or Bulimia Nervosa.

F. 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.

Associated Feature

Some individuals report that binge eating is triggered by dysphoric moods, such as depression and anxiety. Others are unable to identify specific precipitants but may report a nonspecific feeling of tension that is relieved by the binge eating. Some individuals describe a dissociative quality to the binge episodes (feeling “numb” or “spaced out”). Many individuals eat throughout the day with no planned meal times.

These individuals are seen in clinical setting have varying degrees of obesity. Most have a long history of repeated efforts to diet and feel desperate about their difficulty in controlling food intake. Some continue to make attempts to restrict caloric intake, whereas others have given up on all efforts to diet because of repeated failures. In weight-control clinics, individuals with this eating pattern are, on average, more obese and have a history of more marked weight fluctuations than individuals without this pattern. In non-patient community samples, most individuals without this eating pattern are overweight (although some have never been overweight).

These Individuals may report that their eating or weight interferes with their relationships with other people, with their work, and with their self-esteem. In comparison with individuals of equal weight without this pattern of eating, they report higher rates of self-loathing, disgust about body size, depression, anxiety, somatic concern, and interpersonal sensitivity. There may be higher lifetime prevalence of Major Depressive Disorder, Substance-Related Disorders, and Personality Disorders. Individuals suffering from this disorder also report a lower sexual drive and level of self-satisfaction and higher levels of embarrassment and guilt.

Individuals who develop BED often come from families who put an unnatural emphasis on the importance of food. For example, these families may use food as a source of comfort in times of emotional distress. As children, BED patients may have been taught to clean their plates regardless of their appetite, or to be a good girl or boy and finish all of the meal. Cultural attitudes towards beauty and thinness may also be a factor in BED.

Etiology

The causes of binge eating disorder is still unknown. BED patients are also more likely to have an additional diagnosis of impulsive behaviors (for example, compulsive shopping), post-traumatic stress disorder (PTSD), panic disorder, or personality disorders. Due to the high rates of depression seen in patients who compulsively eat, the two disorders are suspected to be linked. Whether binge eating disorder causes depression or if depression causes the disorder is still unknown. Risk increases with depression, anorexia nervosa, stress caused by lifestyle changes, such as moving or starting a new job, or a neurotic preoccupation with being physically attractive.

Epidemiology

In samples drawn from weight-control programs, the overall prevalence varies from approximately 15% to 50% (with a mean of 30%), with females approximately 1.5 times more likely to have this eating pattern than males. In non-patient community samples, a prevalence rate of 0.7% – 4% has been reported.

Empirically supported treatment

The onset of binge eating is in the late adolescence or in the early 20’s, often coming soon after significant weight loss from dieting. Among individuals presenting for treatment, the course appears to be chronic.

• Psychotherapy
  • Cognitive behavioral therapy: Some studies show that cognitive behavioral therapy may help you cope better with issues that may trigger binge-eating episodes, such as negative feelings about your body or a depressed mood. It may also give you a better sense of control over your behavior and eating patterns. However, cognitive behavioral therapy hasn’t been shown helpful in reducing weight. So if you’re overweight, you may need additional treatment.
  • Interpersonal therapy: Interpersonal therapy focuses on your current relationships with other people. This may help reduce binge eating that’s triggered by poor relationships and unhealthy communication skills. The goal is to improve your interpersonal skills — how patients relate to others, including family, friends, and colleagues. The patients learn how to evaluate the way they interact with others and develop strategies for dealing with relationship and communication problems.
  • Dialectical behavior therapy: This form of therapy can help patients learn behavioral skills to help their tolerate stress, regulate their emotions and improve their relationships with others, all of which can reduce the desire to binge eat.
  • Allopathic Treatment: Antidepressants may be prescribed for BED patients. SSRI’s, such as Prozac, are usually preferred because they offer fewer side effects. However, clinical studies don’t show much effectiveness for use of antidepressants in treating BED. Psychotherapy have produced better results. Once the binge eating behavior is curbed and depressive symptoms are controlled, the physical symptoms of the disorder can be addressed.
• Medications
  • Antidepressants: Antidepressants, known as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) may be helpful for binge eating. It’s not clear how these can reduce binge eating, but it may be related to how they affect certain brain chemicals associated with mood.
  • The anticonvulsant topiramate (Topamax): Normally used to control seizures, topiramate has also been found in some studies to reduce binge-eating episodes. However, it can cause serious side effects, including blurred vision, double vision, clumsiness or unsteadiness, dizziness, drowsiness, and trouble in thinking.
  • The anti-obesity medication sibutramine (Meridia): Officially included in the group of antidepressants known as serotonin and norepinephrine reuptake inhibitors (SNRIs), sibutramine has been FDA approved for long-term obesity treatment. Sibutramine may be most helpful if you have binge-eating disorder and are obese. It’s been found to suppress hunger and make you feel full, leading to weight loss. However, it can cause dangerous changes in your blood pressure and other side effects.

Links

• Distinguishing Binge Eating Disorder from Bulimia Nervosa
• The following link features two individuals providing their own personal story with Binge Eating
  • This link continues the conversation with the two individuals from the above vidoe on Binge Eating
• The following link connects to an article on APA’s website titled Binge-Eating Disorder: What’s the Best Treatment?
• The following link connects to an audio interview on NPR with Neal Conan and Ron Saxen, author of the book “The Good Eater: The True Story of One Man’s Struggle With Binge Eating Disorder”.
• Video: http://www.encyclopedia.com/video/jphOUvVt7KA-binge-eating-disorder-my-secret.aspx