What is binge eating disorder?
Binge eating disorder is a mental health condition that is characterized by recurrent episodes of binge eating without efforts on the part of affected individuals to compensate by undoing the binge episodes. Examples of such undoing behaviors include purging food by inducing vomiting, excessively exercising, and/or inappropriately using medications like laxatives or diet pills. This illness was often previously described by mental health professionals under the diagnosis of eating disorder, not otherwise specified rather than as its own separate entity, but the most recent revision of the widely accepted diagnostic manual used by mental health professionals has included binge eating disorder as a separate diagnosis.
Statistics about binge eating disorder indicate that this condition is the most common of all eating disorders, affecting about 3.5% of women and 2% of men over the course of a lifetime. As with other eating disorders like anorexia nervosa or bulimia nervosa, there tends to be no significant difference in the age at which males and females develop binge eating disorder. Males with eating disorders like binge eating disorder tend to have a much higher body mass index (BMI) and are more likely to also suffer from attention deficit hyperactivity disorder (ADHD) compared to males of similar age without the disorder. Females with eating disorders like binge eating disorders are at increased risk for also having celiac disease and diabetes.
Binge eating disorder is apparently quite common in individuals who seek treatment for obesity in weight-loss programs that are affiliated with a hospital. About one-third of individuals with this condition are males. Most develop the disorder during adolescence or early adulthood, primarily in early adulthood. There seems to be no difference in the incidence of binge eating disorder among ethnic groups.
Binge eating disorder can have a significant impact on the health of those who suffer from it. Specifically, about 65% of people with binge eating disorder are obese (20% overweight or more), with even more being generally overweight. Individuals who develop binge eating disorder are at higher risk of also having another psychiatric illness, like depression, anxiety, and substance abuse. Women with this illness tend to suffer from a negative body image, whereas men are more likely develop a substance-use disorder. Other important facts about binge eating disorder include its tendency to last for more than 14 years, with only 7% resolving after the first year of having the illness. When compared to other eating disorders like bulimia nervosa or anorexia nervosa, which each tend to last less than six years, binge eating disorder has more of a chronic course.
Eating Disorders: Anorexia, Bulimia, Binge Eating
Binge Eating Disorder Symptoms and Signs
The hallmark symptom of binge eating disorder is recurring episodes of bingeing, or eating excessive amounts of food at one time, without associated purging behaviors like vomiting, exercising, or medication abuse. Other symptoms include
- eating when under stress,
- feeling as if one is starving,
- rapid eating, and taking longer than normal to feel full,
- eating alone,
- depression, and
- guilt feelings.
What are causes and risk factors for binge eating disorder?
As with most other mental disorders, there is no one specific cause for binge eating disorder. Rather it is the result of a complex group of genetic, psychological, and environmental contributing factors. People who are prone to obesity, either genetically or otherwise, tend to be more at risk for engaging in binge eating episodes and developing binge eating disorder compared to those who are not obese. There is increasing understanding that there can be a genetic component to binge eating disorder, and as with other eating disorders, there are often found to be abnormal levels of brain serotonin and often subtle changes in brain functioning.
Social risk factors for binge eating disorders include a history of being bullied or physically or sexually abused. For Caucasian women as opposed to African-American women, discrimination tends to be a risk factor for this disorder, as well. Other risk factors for binge eating disorder include more exposure to negative comments about shape, weight, and eating. People who participate in competitive sports at an elite level are at higher risk for developing eating disorders in general.
Psychologically, binge eating disorder is thought of by many professionals to be a form of food addiction that is characterized by compulsive overeating. This condition tends to be associated with increased perfectionism, obsessive-compulsiveness, depression, anxiety, and substance-use disorders. Phobias and panic disorder are the most common anxiety problems experienced by people with binge eating disorder. Eating binges tend to be triggered by a number of things, like dietary restrictions, hunger, and negative moods.
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What are binge eating disorder symptoms and signs?
Binge eating disorder symptoms and signs include recurring episodes of binge eating (consuming excessively large amounts of food) without purging (self-induced vomiting), excessive exercising, the inappropriate use of medications, or any other unhealthy behaviors that are often used by bulimic individuals to attempt to compensate for the binge episodes. People with this mental illness tend to engage in stress or other emotional eating, take longer to feel full, and are more likely to feel like they are starving when they are not. The binge episodes are associated with at least three of the following characteristics:
- Eating faster than normal
- Eating large amounts of food when not physically hungry
- Eating until uncomfortably full
- Eating alone because of feeling embarrassed about their eating behaviors
- Feeling disgusted with oneself, sad, or guilty after overeating
Also, the individual with binge eating disorder experiences marked distress regarding their binge eating.
How do health care professionals diagnose binge eating disorder?
As is true with virtually any mental health diagnosis, there is no one test that definitively indicates that someone has binge eating disorder. Therefore, health care professionals assess this disorder by gathering comprehensive medical, family, and mental health information. The health care professional will also either conduct a physical examination or ask that the individual's primary care doctor perform one. The medical assessment will usually include lab tests to evaluate the person's general health and to explore whether or not the person has a medical condition that has what appear to be mental health symptoms.
In asking questions about psychological symptoms, mental health professionals are often exploring if the individual suffers from symptoms that meet diagnostic criteria for binge eating disorder or another eating disorder, like anorexia nervosa and bulimia nervosa, as described in the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-V). To qualify for the diagnosis of binge eating disorder, the person must engage in bingeing at least once per week for three months. The DSM-IV-TR and earlier editions of the diagnostic handbook did not include binge eating disorder as a diagnosis. Rather, it was captured under the diagnosis of Eating Disorder, Not Otherwise Specified (ED, NOS).
Practitioners will also explore whether symptoms of depression and/or mania, anxiety, substance abuse, hallucinations or delusions, as well as some behavioral disorders are occurring. People with binge eating disorder may seem to engage in compulsive eating, having symptoms in common with obsessive compulsive disorder (OCD). Health care professionals may provide the people they evaluate with a quiz or self-test as a screening tool for binge eating disorder and other eating disorders. Since some of the symptoms of binge eating disorder can also occur with other conditions, the mental health screening is designed to determine if the individual suffers from any emotional problem. In order to assess the person's current emotional state, health care professionals conduct a mental-status examination, as well.
Eating Disorders: Anorexia, Bulimia, Binge Eating
What is the treatment for binge eating disorder?
As with obese individuals without binge eating disorder, people with this illness tend to lose weight from adopting a low-calorie diet and engaging in regular exercise, and some will experience repeated weight gain in the long term. While considered adjunctive rather than primary forms of treatment, home remedies like meditation may help reduce the frequency and severity of binge eating disorder symptoms, thereby decreasing the impact of those symptoms on the self-rating scale.
Medications that have been found to be effective in reducing the number and amount of binge episodes in binge eating disorder include lisdexamfetamine (Vyvanse), which is used to treat attention deficit hyperactivity disorder (ADHD) and has been approved by the U.S. Food and Drug Administration to treat binge eating disorder, topiramate (Topamax), which is used to treat seizures, as well as serotonergic (SSRI) medications that treat anxiety (antianxiety medications) or depression (antidepressants), like fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), vortioxetine (Trintellix), and vilazodone (Viibryd). Sibutramine (Meridia) is an appetite suppressant that has been found to help decrease binge eating and enhance weight loss. SSRIs tend to be well tolerated and have a low incidence of side effects like stomach upset, sleep problems, and sexual dysfunction. Topiramate was first used to treat seizures and is sometimes stopped by patients because of daytime sleepiness, difficulty thinking, and poor coordination. Sibutramine's most common side effects include headache, constipation, stomach upset, insomnia, and painful menstrual periods. Less common, more serious side effects of sibutramine include palpitations, chest pain, shortness of breath, nausea, and vomiting.
While psychotherapy alone does not tend to result in long-term weight loss in individuals with binge eating disorder, it can be a key part of the rehabilitation ("rehab") and recovery from the emotional problems that are often associated with this disorder. Two forms of psychotherapy that have been found to be effective in that regard include cognitive behavioral therapy (CBT) and interpersonal therapy (ITP). In cognitive behavioral therapy, the mental health practitioner works to help the person with binge eating disorder identify, challenge, and decrease negative thinking and otherwise dysfunctional belief systems that precipitate unwanted behaviors. Dialectical behavior therapy, which is a specific form of cognitive behavioral therapy that focuses on emotional regulation, has also been found to be an effective means of increasing the length of time between binge episodes (for example, binge abstinence) in preliminary studies. The goal of interpersonal therapy tends to be identifying and managing problems the sufferer of binge eating disorder may have in his or her relationships with others. Participation in one of a number of self-help support groups, like Overeaters Anonymous or Eating Disorders Anonymous, can also be an important part of managing this condition by enhancing the sufferer's self-control in regard to their food intake.
Understanding and addressing how to treat other mental health problems that might co-occur (comorbidity) with binge eating disorder are important aspects of overcoming this illness. For example, as about 57% of men and 28% of women with binge eating disorder also have a substance-use disorder, treating both problems will enhance the successful recovery from each illness.
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What are complications and the prognosis of binge eating disorder?
People with binge eating disorder seem to be at higher risk of developing substance abuse or another psychiatric illness, high blood pressure and other forms of heart disease, type II diabetes, gallbladder disease, some forms of cancer, and abnormal cholesterol levels (for example, high levels of total cholesterol and of so-called bad cholesterol types, plus low levels of good cholesterol) compared to similar-weight individuals without this eating disorder. The obesity that often results from binge eating disorder also puts sufferers at risk for problems like menstrual problems and joint and muscle pain. Pregnant women are at risk for developing problems with the pregnancy like hyperemesis, having babies who have low birth weight, excessively small skulls (microcephaly), and are small for gestational age. Given these potentially life-threatening complications of binge eating disorders, the decreased likelihood that ethnic minorities in the United States seek and are referred for specific treatment is an important obstacle to overcome.
After about six years, a little more than half of individuals with binge eating disorder who have engaged in intensive treatment have been found to have some significant decrease in symptoms, while about one-third have only intermediate outcome, about 6% have poor outcome, and 1% may die during that period of time. Having one eating disorder increases the risk that the sufferer will develop another one. Eating disorders in general and binging behavior specifically can increase the likelihood that a person engages in self-injurious behaviors like cutting or has suicidal thoughts or actions. However, it is important to note that the prognosis of binge eating disorder seems to be quite changeable over time.
Is it possible to prevent binge eating disorder?
Teaching teens and adults about resisting society's pressure toward thinness, understanding what determines body weight, the negative effects of eating disorders, and encouraging good self-esteem, stress management, healthy weight control, and acceptance of their body have been found to be helpful in the prevention of eating disorders. Educating the adults in the lives of youth about how to positively influence children regarding healthy eating habits, exercise and body image have also been determined to be helpful components in preventing binge eating disorder. In addition to parents, key adults in this approach can include teachers and other school staff, coaches, pediatricians, and other primary care doctors.
Medically Reviewed on 12/14/2017
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