Binge eating disorder

Binge Eating Disorder (BED) is a serious and common eating disorder characterized by recurrent episodes of binge eating without regular compensatory behaviors such as purging, fasting, or excessive exercise. It is distinct from other eating disorders like anorexia nervosa and bulimia nervosa, though it shares some psychological characteristics. BED is officially recognized in the DSM-5 and is associated with physical, emotional, and psychological health consequences.

Periwinkle ribbon, symbol of eating disorder awareness

History

The term "binge eating disorder" was first introduced by psychiatrist Albert Stunkard in 1959, who initially described the behavior as part of "night eating syndrome". It was later recognized as a separate diagnostic entity in the early 1990s. BED was formally added to the DSM-5 in 2013 as a distinct eating disorder.

Diagnostic Criteria

According to the DSM-5, BED is characterized by:

• Recurring episodes of binge eating (at least once a week for three months), defined as:
  • Eating, in a discrete period, an amount of food larger than most people would eat under similar circumstances.
  • A sense of lack of control during the episode.
• Episodes are associated with at least three of the following:
  • Eating much more rapidly than normal
  • Eating until uncomfortably full
  • Eating large amounts of food when not physically hungry
  • Eating alone due to embarrassment
  • Feeling disgusted, depressed, or guilty afterward
• Marked distress regarding binge eating
• The behavior is not associated with regular compensatory behaviors (as seen in bulimia nervosa)

Causes and Risk Factors

The exact causes of BED are not fully understood, but a combination of biological, psychological, and environmental factors likely contribute. These include:

• Genetics and family history
• Hormonal or neurochemical imbalances (e.g., dopamine, serotonin)
• Psychological factors such as depression, anxiety disorders, and low self-esteem
• History of trauma, abuse, or neglect
• Chronic dieting and body image dissatisfaction
• Social and cultural pressures around body weight and appearance

Signs and Symptoms

Symptoms may include:

• Frequent episodes of consuming large quantities of food
• A feeling of loss of control while eating
• Eating in secret or alone
• Emotional distress before, during, or after binging
• Fluctuations in weight
• Feelings of shame or guilt related to eating
• Avoidance of social activities involving food

Health Complications

BED is often associated with obesity, though individuals with normal weight can also be affected. Potential health risks include:

• Type 2 diabetes
• Cardiovascular disease
• High blood pressure
• High cholesterol
• Gallbladder disease
• Polycystic ovary syndrome (PCOS)
• Sleep apnea
• Gastrointestinal problems
• Menstrual irregularities and fertility issues

BED is also associated with mental health disorders such as:

• Major depressive disorder
• Generalized anxiety disorder
• Post-traumatic stress disorder (PTSD)
• Substance use disorders

Diagnosis

Diagnosis involves a clinical assessment by a healthcare professional, often including:

• Structured interviews
• Self-reported questionnaires
• Medical history and physical exam
• Psychological evaluation

Treatment

BED is treatable. Treatment options include:

Psychotherapy

• Cognitive behavioral therapy (CBT): The most effective evidence-based treatment
• Interpersonal therapy (IPT)
• Dialectical behavior therapy (DBT)

Medications

• Lisdexamfetamine (Vyvanse), the only FDA-approved medication for BED
• Antidepressants (SSRIs)
• Topiramate and other off-label medications

Nutritional Counseling

• Education on balanced eating patterns
• Development of structured meal plans
• Support for intuitive and mindful eating

Support Groups

• Peer-led support (e.g., Overeaters Anonymous)
• Community-based recovery programs

BED and Reproductive Health

BED can affect fertility and pregnancy:

• Interferes with ovulation
• Increases risk of gestational diabetes, preeclampsia, and postpartum depression
• Can be triggered or exacerbated by hormonal changes during pregnancy and postpartum

Epidemiology

• BED affects approximately 3.5% of women and 2.0% of men in the United States
• It is the most common eating disorder across racial and ethnic groups
• Onset is typically in late adolescence to early adulthood

Prognosis

With early intervention and comprehensive treatment, recovery is possible. Many individuals recover fully, though some may experience relapses. Long-term follow-up and support improve outcomes.

See Also

• Eating disorders
• Bulimia nervosa
• Anorexia nervosa
• Obesity
• Body dysmorphic disorder
• Mental health
• Intuitive eating
• Cognitive behavioral therapy

External Links

• National Institute of Mental Health - Eating Disorders
• National Eating Disorders Association (NEDA)
• Office on Women's Health - Eating Disorders

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