Binge eating disorder

Binge eating disorder (BED) is an eating disorder characterized by binge eating without subsequent purging episodes. The disorder 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 exclusive 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 63.6% for those with subclinical BED.

Signs and symptoms
All of the following are DSM-IV criteria 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. Also, an individual must have 3 or more of the following symptoms:
 * Each binge consists of 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, and is accompanied by a feeling of loss of control (i.e. they feel that they cannot stop eating and cannot control what they are eating and how much they are eating).
 * Anywhere between 5,000 and 15,000 calories are consumed within a binge sitting.
 * The binge eating occurs, on average, at least twice a week for 6 months.
 * The binge eating is not associated with the recurrent use of appropriate compensatory behavior and does not occur exclusively during the course Bulimia Nervosa or Anorexia Nervosa.
 * The person is seriously worried about the binge eating.


 * Feels disgusted, depressed, or guilty after binge eating.
 * Eats an unusually large amount of food at one time, far more than a regular person would eat.
 * Eats much more quickly during binge episodes than during normal eating episodes.
 * Eats until physically uncomfortable and nauseated due to the amount of food consumed.
 * Eats when bored or depressed
 * Eats large amounts of food even when not really hungry.
 * Often eats alone during periods of normal eating, owing to feelings of embarrassment about food.

Causes
A correlation between dietary restraint and the occurrence of binge eating has been convincingly shown in several investigations.

While binge eaters are often believed to be lacking in self-control, the root of such behavior might instead be linked to rigid dieting practices. Binge eating may begin when individuals recover from an adoption of rigid eating habits. 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 consumes a large amount of food in a relatively short period of time.

The relationship between strict dieting and later binging may explain the high numbers of people who become trapped in a cycle of dieting and weight gain, often reaching higher and higher weights after each round of dieting and binging.

Comorbidities
Individuals who have binge eating disorder commonly have other psychiatric comorbidities such as major depressive disorder, personality disorder, bipolar disorder, substance abuse, body dysmorphic disorder, kleptomania, irritable bowel syndrome, fibromyalgia, or anxiety disorder. Binge eating symptoms are also present in bulimia nervosa. The formal diagnosis criteria differ, however, 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. (This has changed in the DSM-5). Unlike in bulimia, those with BED do not exhibit compensatory behaviors such as purge, fast or engaging in compensatory strenuous exercise after binge eating episodes. Additionally, bulimics are typically of normal weight, are underweight but have been overweight before, or are somewhat overweight. Those with BED are more likely to be 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. The DSM-IV categorizes it under Eating disorder not otherwise specified (EDNOS), an indication that more research is needed. As of 2013 and the publication of the DSM-5, binge eating disorder no longer falls under EDNOS - it has its own diagnosis as an eating disorder.

Epidemiology
Binge eating disorder is the most common eating disorder in adults. The lifetime prevalence of binge eating disorder has been observed in studies to be 2.0% for men and 3.5% for women, higher than that of the commonly recognized eating disorders anorexia nervosa and bulimia nervosa. The disorder is also associated with the development of severe obesity.

The disorder is found in all cultures and ethnicities. People who are obese and have binge eating disorder often became overweight at an earlier age than those without the disorder. They might also lose and gain back weight more often, or be hypervigilant about gaining weight.

Other risk factors may include childhood obesity, critical comments about weight, low self-esteem, depression, and physical or sexual abuse in childhood. A study in behavior genetics has also suggested that binge eating disorder may have a genetic component. It has been found that 20% of relatives of obese individuals with binge eating disorder also have binge eating disorder, compared to 9% of relatives of obese individuals without binge eating disorder.

Complications and health risks
While people of a healthy weight may overeat occasionally, an ongoing habit of consuming large amounts of food in a short period of time ultimately leads to weight gain and obesity. The main health consequences of this type of eating disorder are brought on by the weight gain resulting from the binging episodes.

People with binge eating disorder may become ill due to a lack of proper nutrition. Binging episodes usually include foods that are high in fat, sugar, and/or salt, but low in vitamins and minerals. Individuals are often upset about their binge eating and may become depressed. Those who are obese and also have BED are at risk for common comorbidities associated with obesity such as type 2 diabetes mellitus, cardiovascular disease (e.g., high blood pressure and heart disease), gastrointestinal issues (e.g., gallbladder disease), high cholesterol levels, musculoskeletal problems and obstructive sleep apnea.

Individuals suffering from BED often have a lower overall quality of life and commonly experience social difficulties. Most people with binge eating disorder have tried to control it on their own, but have not been able to for an extended period of time.

Treatment
People with binge eating disorder can seek help from health professionals including physicians, nutritionists, psychiatrists, psychologists, clinical social workers or by attending 12-step Overeaters Anonymous or Food Addicts in Recovery Anonymous meetings. Even those who are not overweight are usually upset by their binge eating, and treatment can help them. Cognitive behavioral therapy (CBT) treatment has been demonstrated as a more effective form of treatment for BED than behavioral weight loss programs with 50% of BED individuals achieving complete remission from binge eating. CBT has also been shown to be an effective method to address self-image issues and psychiatric comorbidities (e.g., depression) associated with the disorder. Recent reviews have concluded that psychological interventions such as psychotherapy and behavioral interventions are more effective than pharmacological interventions for the treatment of binge eating disorder.

Although mental health professionals may be attuned to the signs of binge eating disorders, many physicians do not raise the question, often because they are uninformed about the specifics of the condition. Because it was not a recognized psychiatric disorder in the DSM-IV, it has been difficult to obtain insurance reimbursement for treatments. However, with the publication of DSM-5, BED has now been included as an eating disorder in its own right, instead of as part of the EDNOS category as in the DSM-IV.

Bariatric surgery has also been proposed as another approach to treat BED and a recent meta-analysis showed that approximately two-thirds of individuals who seek this type of surgery for weight loss purposes have BED. Bariatric surgery recipients who had BED prior to receiving the surgery tend to have poorer weight-loss outcomes and are more likely to continue to exhibit eating behaviors characteristic of BED.

Pharmacologic treatment
Three classes of medications are typically used in the treatment of binge eating disorder: antidepressants, anticonvulsants, and anti-obesity medications. Antidepressant medications of the selective serotonin reuptake inhibitor (SSRI) class such as fluoxetine, fluvoxamine, or sertraline have been found to effectively reduce episodes of binge eating and reduce weight. Similarly, anticonvulsant medications such as topiramate and zonisamide may be able to effectively suppress appetite. The long-term effectiveness of medication for binge eating disorder is currently unknown.