(See also Introduction to Eating Disorders Introduction to Eating Disorders Eating disorders involve a persistent disturbance of eating or of behavior related to eating that Alters consumption or absorption of food Significantly impairs physical health and/or psychosocial... read more .)
Binge-eating disorder affects about 3.5% of women and 2% of men in the general population during their lifetime. Unlike bulimia nervosa Bulimia Nervosa Bulimia nervosa is characterized by recurrent episodes of binge eating followed by some form of inappropriate compensatory behavior such as purging (self-induced vomiting, laxative or diuretic... read more , binge-eating disorder occurs most commonly among overweight and obese people and contributes to excessive caloric intake; it may be present in ≥ 30% of patients in some weight-reduction programs. Compared with people with anorexia nervosa Anorexia Nervosa Anorexia nervosa is characterized by a relentless pursuit of thinness, a morbid fear of obesity, a distorted body image, and restriction of intake relative to requirements, leading to a significantly... read more or bulimia nervosa, those with binge-eating disorder are older and more likely to be male.
Symptoms and Signs of Binge-Eating Disorder
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 ("grazing").
People with binge-eating disorder are distressed by it. Mild to moderate depression Depressive Disorders Depressive disorders are characterized by sadness severe enough or persistent enough to interfere with function and often by decreased interest or pleasure in activities. Exact cause is unknown... read more and preoccupation with body shape, weight, or both are more common in obese people with binge-eating disorder than in people of similar weight who do not binge eat.
Diagnosis of Binge-Eating Disorder
Clinical criteria for diagnosis of binge-eating disorder require that
Binge eating occurs, on average, at least once/week for 3 months
Patients have a sense of lack of control over eating
In addition, ≥ 3 of the following must be present:
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 Bulimia Nervosa Bulimia nervosa is characterized by recurrent episodes of binge eating followed by some form of inappropriate compensatory behavior such as purging (self-induced vomiting, laxative or diuretic... read more (which also involves binge eating) by the absence of compensatory behaviors (eg, self-induced vomiting, use of laxatives or diuretics, excessive exercise, fasting).
Treatment of Binge-Eating Disorder
Sometimes interpersonal psychotherapy
Consideration of drug therapy, usually selective serotonin reuptake inhibitors (SSRIs) or lisdexamfetamine
Cognitive-behavioral therapy is the most studied and best supported treatment for binge-eating disorder. But interpersonal psychotherapy appears equally effective; both result in remission rates of ≥ 60%, and improvement is usually well-maintained over the long term. These treatments do not produce significant weight loss in obese patients.
Conventional behavioral weight-loss treatment has short-term effectiveness in reducing binge eating, but patients tend to relapse. Antidepressant drugs (eg, SSRIs Selective Serotonin Reuptake Inhibitors (SSRIs) Several drug classes and drugs can be used to treat depression: Selective serotonin reuptake inhibitors (SSRIs) Serotonin modulators (5-HT2 blockers) Serotonin-norepinephrine reuptake inhibitors... read more ) 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 (eg, topiramate) or weight-loss drugs (eg, orlistat) may be helpful.
People with binge-eating disorder tend to be overweight and obese.
Diagnose binge-eating disorder based on clinical criteria (including binge eating, on average, at least once/week for 3 months, with a sense of lack of control over eating).
Treat with cognitive-behavioral therapy or interpersonal psychotherapy and sometimes drugs (eg, SSRIs, lisdexamfetamine).