Binge eating disorder

Binge eating disorder is a psychiatric disorder in which a subject:

periodically does not exercise control over consumption of food
eats an unusually large amount of food at one time
eats much more quickly during binge episodes than during normal eating episodes
eats until physically uncomfortable
eats large amounts of food, even when they are not really hungry
always eats alone during binge eating episodes, in order to avoid discovery of the disorder
often eats alone during periods of normal eating, owing to feelings of embarrassment about food
feels disgusted, depressed, or guilty after binge eating

Binge eating is an element of another eating disorder, bulimia nervosa. In Bulimia, however, episodes of binge eating are followed by purging, periods of fasting, or performance of strenuous exercise - indeed, "exercise bulimia," in which a person eats normally but then engages in strenuous exercise, is an inverse form of bulimia. People with binge eating disorder, by contrast, do not purge, fast or engage in strenuous exercise after binge eating. Additionally, people with bulimia are typically of normal weight or may be slightly overweight (the purging, etc., have little to no effect on the subject's body fat), whereas people with binge eating disorder are typically overweight or obese.

Binge eating disorder is similar to, but it is distinct from, compulsive eating. People with binge eating disorder do not have a compulsion to overeat and do not spend a great deal of time fantasising about food. On the contrary, some people with binge eating disorder have very negative feelings about food. As with other eating disorders, binge eating is an expressive disorder - that is, the disorder is an expression of a deeper, psychological problem.

It is actually hotly contested whether binge eating disorder has its own diagnosis. Some believe that it is a milder form, or subset of bulimia nervosa, but others argue that it is its own distinct disorder. Currently, the DSM-IV categorizes it under Eating Disorder Not Otherwise Specified (ED(NOS)), simply stating that more research is needed.

Occurrence and risk factors

Binge eating disorder is probably the most common eating disorder. Most people with this problem are either overweight or obese (discussed below), but people of normal weight can also have the disorder.

About 2 percent of all adults in the United States (as many as 4 million Americans) have binge eating disorder. About 10 to 15 percent of people who are mildly obese and who try to lose weight on their own or through commercial weight-loss programs have binge eating disorder. The disorder is even more common in people who are severely obese.

Binge eating disorder is a little more common in women than in men; three women for every two men have it. The disorder is found in all ethno-cultural and racial populations, not just among people of Euro-Caucasian ancestry.

People who are obese and have binge eating disorder often became overweight at a younger age than those without the disorder. They might also lose and gain back weight (yo-yo diet) more often.

As to the distinctions "overweight" and "obese," the 1998 National Institutes of Health Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults artificially defines overweight as a body mass index (BMI) of 25 to 29.9 and obesity as a BMI of 30 or more. BMI is calculated by dividing weight (in kilograms) by height (in meters) squared.

Causes

No one knows for sure what causes binge eating disorder. As many as half of all people with binge eating disorder have been depressed in the past. Whether depression causes binge eating disorder or whether binge eating disorder causes depression is not known.

Many people who are binge eaters say that being angry, sad, bored, or worried can cause them to binge eat. Impulsive behavior (acting quickly without thinking) and certain other emotional problems can be more common in people with binge eating disorder.

It is also unclear if dieting and binge eating are related. Some studies show that about half of all people with binge eating disorder had binge episodes before they started to diet.

Researchers also are looking into how brain chemicals and metabolism (the way the body uses food energy) affect binge eating disorder. This research is still in the early stages.

Complications

People with binge eating disorder can get sick because they may not be getting the right nutrients. They usually eat large amounts of fats and sugars, which don't have a lot of vitamins or minerals.

People with binge eating disorder are usually very upset by their binge eating and may become very depressed.

People who are obese and also have binge eating disorder are at risk for

Most people with binge eating disorder have tried to control it on their own, but have not been able to control it for very long. Some people miss work, school, or social activities to binge eat. Persons who are obese with binge eating disorder often feel bad about themselves and may avoid social gatherings.

Most people who binge eat, whether they are obese or not, feel ashamed and try to hide their problem. Often they become so good at hiding it that even close friends and family members don't know they binge eat.

Dieting

People who are not overweight should avoid dieting because it sometimes makes their binge eating worse. Dieting here means skipping meals, not eating enough food each day, or avoiding certain kinds of food (such as carbohydrates or fats). These are unhealthy ways to try to change your body shape and weight. Many people with binge eating disorder are obese and have health problems because of their weight. People with binge eating disorder who are obese may find it harder to stay in a weight-loss program. They also may lose less weight than other people, and may regain weight more quickly. (This can be worse when they also have problems like depression, trouble controlling their behavior, and problems dealing with other people.) These people may need treatment for binge eating disorder before they try to lose weight.

Treatment

People with binge eating disorder, whether or not they want to lose weight, should get help from a health professional such as a psychiatrist, psychologist, or clinical social worker for their eating behavior. Even those who are not overweight are usually upset by their binge eating, and treatment can help them. There are several different ways to treat binge eating disorder. Cognitive-behavioral therapy teaches people how to keep track of their eating and change their unhealthy eating habits. It also teaches them how to change the way they act in tough situations. Interpersonal psychotherapy helps people look at their relationships with friends and family and make changes in problem areas. Drug therapy, such as antidepressants, may be helpful for some people.

Researchers are still trying to find the treatment that is the most helpful in controlling binge eating disorder. The methods mentioned here seem to be equally helpful. For people who are overweight, a weight-loss program that also offers treatment for eating disorders might be the best choice.

If you think you might have binge eating disorder, it's important to know that you are not alone. Most people who have the disorder have tried but failed to control it on their own. You may want to get professional help. Talk to your health care provider about the type of help that may be best. The good news is that most people do well in treatment and can overcome binge eating.

References

Fairburn, C.G. (1995). Overcoming Binge Eating. New York: Guilford Press, ISBN 0898629616. This book discusses who binges and why, how bingeing differs from overeating, and how a binge eater can gain control. It presents a step-by-step program for overcoming binge eating.
Grilo, C.M. (1998). "The Assessment and Treatment of Binge Eating Disorder." Journal of Practical Psychiatry and Behavioral Health 4 pp. 191–201. This article, written for health professionals, reviews the literature on binge eating disorder with a particular focus on its assessment and treatment. Implications for practice and future research are discussed.
Siegel, M.; Brisman, J.; & Weinshel, M. (1988). Surviving an Eating Disorder: New Perspectives and Strategies for Family and Friends. New York: Harper & Row, ISBN 006015859X. This book discusses family therapy, psychopharmacology, hospitalization policies, insurance coverage, and support services for binge eating disorder patients and their families.
Stunkard, A.J. (1959). "Eating Patterns and Obesity." Psychiatric Quarterly 33 pp. 284–295. This classic paper provides one of the first descriptions of binge eating in obese individuals.
Yanovski, S.Z. (1993). "Binge Eating Disorder: Current Knowledge and Future Directions." Obesity Research 1 (4) pp. 306–323. This review of existing research on binge eating disorder, geared to health professionals, describes treatment methods, discusses their effectiveness, and recommends that doctors treating obese patients be aware of the disorder.

External links

This article is taken from the public domain NIH Publication No. 99-3589, updated February 2001.

Eating disorders | Medical conditions related to obesity

Binge Eating | Hyperphagie | Eetbuienstoornis | BED

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