DSM Diagnostic Criteria
Recurrent episodes of binge eating, which is characterized by
- eating, in a discrete period of time, an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances, and
- a sense of lack of control over eating during the episode
The binge-eating episodes are associated with three or more of the following
- 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 feeling embarrassed by how much one is eating
- Feeling disgusted with oneself, depressed, or very guilty afterwards
Binge eating disorder (BED) has a reported prevalence of 6.6%, with equal proportions in women and men. The prevalence of BED increases to between 9% and 19% in obesity clinic populations and between 9% and 47% among bariatric surgery patients. Obese patients who have BED appear to be significantly older than non-obese patients who have BED. Additionally, as the degree of obesity increases, the prevalence of BED also seems to increase. This suggests that binge eating may be a risk factor for weight gain and/or obesity. It is important to note that obesity itself is not a criterion of BED, and the disorder is clinically significant and distinct from typical obesity.
In comparison to obese patients without BED, obese patients with the disorder have lower self-esteem and greater depressive symptoms. Obese patients with BED also have more comorbid psychiatric disorders such as mood, anxiety, and substance use disorders. When comparing individuals diagnosed with BED, obesity, and bulimia nervosa, studies show that the characteristics of BED appear to be more similar to bulimia nervosa than to obesity. However, the binge eating episodes are more clearly defined in patients with bulimia nervosa because their binge eating episodes are followed by compensatory behavior.
Cognitive behavioral therapy (CBT) is the most extensively researched treatment for both BED and bulimia nervosa. The theoretical model behind CBT posits that chronic dieting in an attempt to control weight encourages and maintains binge eating. Thus, treatment focuses on establishing regular eating patterns, decreasing dietary restraint, and combating maladaptive beliefs towards eating and weight. Another treatment for BED is dialectical behavior therapy. This model hypothesizes that individuals with BED have difficulty regulating negative emotions and binge eat to cope with their emotional distress. The temporary relief then reinforces the behavior. Whether utilizing CBT or dialectical behavior therapy, the primary goal of treatment must be the cessation of binge eating. Any emphasis on weight loss is only appropriate once patients have been able to abstain from binge eating. Binge eating continues and can even worsen for individuals with BED in programs that focus solely on the reduction of body weight without addressing the binge eating behavior.
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