Binge eating disorder

Editor(s)-in-Chief: C. Michael Gibson, M.S.,M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Mark Warren, M.D., M.P.H.; Fellow, Academy of Eating Disorders [mailto:mwarren@eatingdisorderscleveland.org]

Overview
Binge eating disorder (BED), is a psychiatric disorder in which a subject shows the following symptoms.
 * Periodically does not exercise control over consumption of food
 * Eats an unusually large amount of food at one time -- 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
 * Eats large amounts of food even when they are 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

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. 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 or slightly overweight, whereas those with binge eating disorder are typically overweight or obese.

Binge eating disorder is similar to, but it is 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 (discussed below), but people of normal weight can also have the disorder.

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.

Binge eating disorder is a little more common in women than in men; three women for every two men have it. 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.

Causes
No one knows for sure what causes binge eating disorder. As many as half of all people with binge eating disorder have been depressed in the past. Whether depression causes binge eating disorder or whether binge eating disorder causes depression is not known for sure.

Emotional cues such as anger, sadness, boredom, and anxiety can trigger binge eating. Impulsive behavior and certain other emotional problems can be more common in people with binge eating disorder. However, many people also claim that binging occurs regardless of their mood.

It is also unclear if 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 are looking into how brain chemicals and metabolism affect binge eating disorder, although this study is in its early stages.

Complications
People with binge eating disorder can get sick due to a lack of proper nutrition. Binging episodes usually include foods that are high in sugar and/or salt, but low in healthier nutrients.

People with binge eating disorder are usually very upset by their binge eating and may become very depressed.

People who are obese and also have binge eating disorder are at risk for type 2 diabetes, high blood pressure, high blood cholesterol levels, 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. Persons who are obese with binge eating disorder often feel bad about themselves and may avoid social gatherings.

Most people who binge eat, whether they are obese or not, feel ashamed and try to hide their problem. Often they become so good at hiding it that even close friends and family members don't know they binge eat.

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 food 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 get help from a health professional including physicians, nutritionists, psychiatrist, psychologists, or clinical social workers for their eating behavior. Even those who are not overweight are usually upset by their binge eating, and treatment can help them. 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 that also offers treatment for eating disorders might be the best choice.

Experimental Treatments
A small (40 people) 10 week double-blind clinical trial was reported in the Journal of Clinical Psychiatry on the effectiveness of Atomoxetine (a prescription ADHD medicine) for treating Binge-Eating Disorder. The results of the trial was that Atomoxetine was "associated with a significantly greater rate of reduction in binge-eating episode frequency, weight, [and] body mass index." The average daily dose given was 106 mg/day. The authors conclude that Atomoxetine is effective for short term treatment of Binge-Eating Disorder.

Unattributed references

 * Fairburn, C.G. (1995). Overcoming Binge Eating. New York: Guilford Press, ISBN 0-89862-961-6. This book discusses who binges and why, how bingeing differs from overeating, and how a binge eater can gain control. It presents a step-by-step program for overcoming binge eating.
 * Grilo, C.M. (1998). "The Assessment and Treatment of Binge Eating Disorder." Journal of Practical Psychiatry and Behavioral Health 4 pp. 191–201. This article, written for health professionals, reviews the literature on binge eating disorder with a particular focus on its assessment and treatment. Implications for practice and future research are discussed.
 * Siegel, M.; Brisman, J.; & Weinshel, M. (1988). Surviving an Eating Disorder: New Perspectives and Strategies for Family and Friends. New York: Harper & Row, ISBN 0-06-015859-X. This book discusses family therapy, psychopharmacology, hospitalization policies, insurance coverage, and support services for binge eating disorder patients and their families.
 * Stunkard, A.J. (1959). "Eating Patterns and Obesity." Psychiatric Quarterly 33 pp. 284–295. This classic paper provides one of the first descriptions of binge eating in obese individuals.
 * Yanovski, S.Z. (1993). "Binge Eating Disorder: Current Knowledge and Future Directions." Obesity Research 1 (4) pp. 306–323. This review of existing research on binge eating disorder, geared to health professionals, describes treatment methods, discusses their effectiveness, and recommends that doctors treating obese patients be aware of the disorder.


 * Portions of this article are taken from the public domain NIH Publication No. 99-3589, updated February 2001.

Binge Eating Hyperphagie むちゃ食い障害 Eetbuienstoornis BED