Binge Eating Disorder

Binge-eating disorder (BED) has joined the ranks with anorexia nervosa (AN) and bulimia nervosa (BN) as an “official” eating disorder. Binge-eating disorder is in fact a distinct entity—not just the extreme overeating that plagues many Americans. No one knows for sure what causes BED.  Similar to anorexia nervosa or bulimia nervosa, the treatment approach is always bio-psycho-social.

BED is now included in the DSM V, which will provide the opportunity for increased awareness and understanding of the severity of this disorder. With the association of BED and obesity, this disorder becomes a major public health issue that presents both medical and psychiatric issues that impair the quality of life.

Binge eating is characterized by insatiable cravings that can occur any time of the day or night, usually secretive, and filled with shame. Bingeing is often rooted in poor body image, use of food to deal with stress, low self-esteem and dysfunctional thoughts.

More common than anorexia nervosa or bulimia nervosa, binge-eating disorder occurs in 1>35 adults in the U.S. This translates to 3-5% of women (about 5 million) and 2% of men (3 million). Although eating disorders are typically twice as common in women, BED seems to be an “equal opportunity” disorder, with 40% occurrence in men. Data also indicates BED does not discriminate with regard to race; BED is as common in African American women as it is in Caucasian and Hispanic women.

BED does not exist in the presence of anorexia nervosa or bulimia nervosa. Although there are similar characteristics between those with BN and BED, those with BED do not purge. There are no compensatory mechanisms associated with the binge to get rid of calories, so individuals with BED are more likely to be overweight or obese, while patients with BN may be underweight, normal weight or overweight.

What does BED look like?

This vicious cycle of recurrent bingeing without purging brings feelings of despair, disgust, and a sense of loss of control. As a consequence of the binge, fears become reality and weight gain follows. As a result, emotional and physical distress can become so severe that work, school and even social relationships begin to be impaired.

Distinguishing between overeating and binge eating is sometimes difficult, even for the eating disorder professionals. Compulsive eating and emotional eating are terms that have been around for years. BED is a distinct entity and not merely the occasional craving, overeating when you are hungry, or the overindulgence during the holidays.  According to Cynthia Bulik, PhD, “Every binge is different, just as every craving is different, and every binge-eater is different but the scenario is the same.”

Criteria for Diagnosis of BED:

  • Loss of control over amount of eating
  • Marked distress over binge episode
  • Occurs at least once per week for 3 months

And, THREE or more of the following:

  • Eating more rapidly than normal
  • Eating until feeling uncomfortably full
  • Eating large amounts of food when not feeling physically hungry
  • Eating alone because of being embarrassed by how much one is eating
  • Feeling disgusted with oneself, depressed or very guilty after overeating

Biological Issues Related to BED:

  • Genetics: Although genes can make it harder to make healthy choices and make fighting weight and BED an uphill battle, genes alone do not totally determine a person’s physical/emotional destiny. Environment, ability to rework thoughts and make other decisions are also factors.
  • Depression: The incidence of depression is very high in individuals with BED and may need to be further evaluated.
  • Restrictive dieting: If you have BED, sticking to a traditional weight loss program may be difficult.

Detection: Unfortunately, many people with BED go under the radar. The pain of struggling with BED is often hidden from family, friends and even doctors.

Some questions to ask:

  • Are there any problems with your eating?
  • Are there binge foods that you know will be a problem?
  • Is your life built around food and eating?
  • Do you feel compelled to binge?
  • Do you eat rapidly and continue to eat, despite feeling uncomfortable?
  • Once you start eating, can you stop?
  • Do you lie about the amount of food consumed? (Note: in our supersized world, calories are deceiving – and even the restaurants that post calories seem to underestimate.)
  • Do you want to eat alone?
  • Do you stash food around the house, car, or desk at work?
  • Do you have feelings of remorse, shame, guilt, disgust or loss of self-esteem after overeating?
  • Do you zone out during overeating?

BED is a treatable disorder. Here are some basic goals for a successful outcome:

  • Decrease/stop bingeing episodes
  • Attain and maintain a healthy weight
  • Treat any co-existing psychiatric disorders
  • Correct any self-defeating thoughts, feelings, behaviors or situations that trigger a binge.

What is the relationship between BED and being obese/overweight?

Obesity is a medical illness, not a psychiatric disorder. It is important to understand that if you are healthy (no medical problems), have a healthy attitude (realistic about weight, body image) and have healthy behaviors (healthy eating habits, moderate exercise) then for the most part, whatever weight you are and can sustain is a healthy weight for you.

Wellness not weight should be the determining factor. Body mass index (BMI) , which defines overweight and obese, is just one factor, not the sole determining factor for wellness.

Being overweight or obese does NOT mean you have BED.
Not everyone who is overweight binges or has BED.  Considering what is “normal” in America culture, giant portion size, sedentary life style and high calorie fast-foods, a person doesn’t have to binge to be overweight.

BED is a psychiatric disorder and is a red flag for both medical and psychological disorders.

Most binge-eaters, however, are overweight or obese, although some may be at normal weight. In weight reduction treatment programs, BED is a frequent phenomenon ranging up to 30%.

In 1997, binge-eating disorder (BED) was included into the DSM-IV as a provisional diagnostic category requiring further study. About 30% of the participants in weight loss programs meet criteria for BED. The prevalence of BED in the general population is 2%; BED is 1.5 times more common in women than men. In treating obese patients with BED, there are several potential goals of treatment, including cessation of binge eating and improvement of eating-related psychopathology (e.g. concerns about weight and shape, restraint eating), weight loss or prevention of further weight gain, improvement of physical health, and reduction of psychiatric comorbidity. Contrary to expectations, weight loss programs do not appear to worsen the eating disorder, and successful treatment of binge-eating does not automatically promote weight loss. Controlled treatment studies have shown that psychotherapeutic approaches and drug treatment may successfully reduce binge-eating episodes in patients with BED. Remission rates are generally high (e.g. 50% and more following cognitive behavioral therapy), and the overall prognosis is better than for patients with bulimia nervosa.