The Binge Eating Disorder
Binge eating disorder (BED) is a severe, life-threatening, and treatable eating disorder characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards; and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating.
Binge eating disorder affects about 3.5% of women and 2% of men in the general population during their lifetime. Unlike bulimia nervosa, binge eating disorder occurs most commonly among overweight and obese people because it contributes to excessive caloric intake; it may be present in ≥ 30% of patients in some weight reduction programs.
BED was first explained in 1959 by Albert Stunkard, a psychiatrist, and researcher, as Night Eating Syndrome (NES). The term Binge Eating Disorder was created to define similar binge eating behaviour without the nocturnal aspect.
Though BED can occur in men and women of normal weight, it often leads to the development of unwanted weight gain or obesity, which can indirectly reinforce further compulsive eating.
Binge eating episodes are typically classified as occurring on average a minimum of twice per week for duration of six months.
During a binge episode, people eat a much larger amount of food than most people would eat in a similar time under similar circumstances. During and after a binge, people feel as if they have lost control. Binge eating is not followed by purging (by inducing vomiting, misusing laxatives, diuretics, or enemas), excessive exercising, or fasting. Binge eating occurs in episodes; it does not involve constant overeating.
People with binge eating disorder are distressed by it. Mild to moderate depression and preoccupation with body shape, weight, or both are more common in obese people with binge eating disorder than in obese people who are not binge eaters.
The Binge-Restrict Cycle:
The minute someone begins a diet and starts to engrain the restricting concept into their mind, they distance themselves farther and farther from their natural eating cues causing them to develop a disordered eating pattern.
Scientific studies have shown that people who eat multiple smaller meals a day were less likely to binge whereas those who ate only a few meals a day had more frequent binge episodes. Some people can diet and not restrict as much and lose weight in a gradual and healthy way.
Warning Signs:
Physical signs may include;
- Noticeable fluctuations in weight, both up and down
- Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
- Difficulties concentrating
While, some of the behavioural signs may include;
- Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food.
- Appears uncomfortable eating around others
- Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)
- Fear of eating in public or with others
- Steals or hoards food in strange places
- Creates lifestyle schedules or rituals to make time for binge sessions
- Withdraws from usual friends and activities
- Frequently diets
- Shows extreme concern with body weight and shape
- Frequent checking in the mirror for perceived flaws in appearance
Causes:
While the exact cause of BED is unknown, there are a variety of factors that are thought to influence the development of this disorder. These factors are;
- Biological: Biological abnormalities, such as hormonal irregularities or genetic mutations, may be associated with compulsive eating and food addiction.
- Psychological: A strong correlation has been established between depression and binge eating. Body dissatisfaction, low self-esteem, and difficulty coping with feelings can also contribute to binge eating disorder.
- Social and Cultural: Traumatic situations, such as a history of sexual abuse, can increase the risk of binge eating. Social pressures to be thin, which are typically influenced through media, can trigger emotional eating. Persons subject to critical comments about their bodies or weight may be especially vulnerable to binge eating disorder.
Consequences:
The consequences of BED involve many physical, social, and emotional difficulties. Some of these complications are:
- Cardiovascular disease
- Type 2 Diabetes
- Insomnia or sleep apnoea
- Hypertension
- Gallbladder disease
- Muscle and/or joint pain
- Gastrointestinal difficulties
- Depression and/or anxiety
Diagnosis:
Clinical criteria for diagnosis of binge eating disorder require binge eating at least once/wk. for 3 mo. and a sense of lack of control over eating, plus the presence of ≥ 3 of the following:
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not feeling physically hungry
- Eating alone because of embarrassment
- Feeling disgusted, depressed, or guilty after overeating
Binge eating disorder is differentiated from bulimia nervosa (which also involves binge eating) by the absence of compensatory behaviours (e.g., self-induced vomiting, use of laxatives or diuretics, excessive exercise, fasting).
Treatment:
- Cognitive-behavioural therapy (CBT)
- Interpersonal psychotherapy (IPT)
- Consideration of drug therapy, usually SSRIs or lisdexamfetamine
CBT is the most studied and best supported treatment for binge eating disorder. Both CBT and IPT result in remission rates of ≥ 60%; improvement is usually well-maintained over the long-term. These treatments do not produce significant weight loss in obese patients.
Conventional behavioural weight loss treatment has short-term effectiveness in reducing binge eating, but patients tend to relapse. Antidepressant drugs (e.g., SSRIs) also have short-term effectiveness in eliminating binge eating, but long-term effectiveness is unknown. Lisdexamfetamine is approved for the treatment of moderate to severe binge eating disorder. It can reduce the number of binge days and appears to cause slight weight loss, but its long-term effectiveness is unknown. Appetite-suppressing drugs (e.g., topiramate) may be helpful.
