Binge Eating Disorder

After first being described in 1959 as “night eating syndrome,” binge eating disorder (BED) is now included as a formal diagnosis in DSM 5. BED is the most prevalent eating disorder (ED) in adults, seen all ethnic and cultural groups, and has 2% and 3.5% lifetime prevalence in males and females, respectively. Clinicians should consider BED diagnosis in individuals with recurrent episodes of binge eating occurring once a week or more, lasting 3 months or longer and characterized both by eating definitely larger amount of food in a similar period and under similar circumstances than most people would eat and by a sense of lack of control over eating during the episodes. The person must experience marked distress regarding binge eating and episodes should be associated with at least 3 of the following: eating much more rapidly than normal, eating until feeling uncomfortably full, eating large amount of food when not feeling physically hungry, eating alone because of embarrassment, and feeling disgusted with oneself, depressed, or very guilty after overeating. BED cannot occur exclusively during the course of anorexia or bulimia nervosa. Risk factors for BED include childhood obesity, depression, low self-esteem, abuse history in childhood, critical comments about weight, strict and yo-yo dieting, and possible genetic predisposition. People with BED do not only face more social difficulties and have lower quality of lives, but also are prone to development of obesity, obstructive sleep apnea, metabolic syndrome or its components including diabetes, cardiovascular, gastrointestinal, and high lipid problems. BED patients usually binge on foods that are high in fat, carbohydrate, and salt. They unexpectedly may have vitamin and mineral deficiencies. Treatment approaches in BED can be categorized into: self-help approaches aiming to manage binge eating and weight, medical/surgical interventions targeting underlying hormonal/metabolic problems, and psychopharmacological and psychological modalities aiming to address underlying and core symptoms and concurrent psychiatric conditions associated with BED. Bariatric surgery has been an effective tool in treating severe obesity, but obese patients with BED seem to have poorer outcomes and some continue to binge eat and gain weight after surgery. Cognitive behavioral therapy (CBT) can achieve 50% remission of binging and seems to be more effective than behavioral weight loss programs. Addressing comorbid psychiatric conditions, which reach as high as 60-70% in BED, by pharmacological tools and CBT would likely provide extra benefits. Some reviews have concluded psychotherapeutic modalities are superior to pharmacological interventions in BED, yet there is good evidence of efficacy for few antidepressant, antiepileptic, and other medications and anecdotal evidence for some other agents. In addition psychotropic medications are proven to be effective in treating comorbid mood, anxiety, trauma, and/or substance abuse disorders that are frequently associated with BED. Unfortunately most health care providers including psychiatrists and psychologists do not screen for BED and not attempt to treat or refer patients with BED, despite it is a formal DSM 5 disorder that cause significant suffering and morbidity and can worsen co-occurring medical and psychiatric problems. Screening and assessing individuals for BED and concurrent conditions at clinics and providing evidence based treatment options would likely improve quality of lives of patients and overall outcomes in BED.