A primer on binge eating disorder diagnosis and management

Abstract

Binge eating disorder (BED) is the most common eating disorder, with an estimated lifetime prevalence of 2.6% among U.S. adults, yet often goes unrecognized. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), BED is defined by recurrent episodes of binge eating (eating in a discrete period of time an amount of food larger than most people would eat in a similar amount of time under similar circumstances and a sense of lack of control over eating during the episode), occurring on average at least once a week for 3 months, and associated with marked distress. It can affect both men and women, regardless if they are at normal weight, overweight, or obese, and regardless of their ethnic or racial group. Psychiatric comorbidities are very common, with 79% of adults with BED also experiencing anxiety disorders, mood disorders, impulse control disorders, or substance use disorders; almost 50% of persons with BED have ≥ 3 psychiatric comorbidities. Multiple neurobiological explanations have been proffered for BED, including dysregulation in reward center and impulse control circuitry, with potentially related disturbances in dopamine neurotransmission and endogenous μ-opioid signaling. Additionally, there is interplay between genetic influences and environmental stressors. Psychological treatments such as cognitive behavioral interventions have been recommended as first line and are supported by meta-analytic reviews. Unfortunately, routine medication treatments for anxiety and depression do not necessarily ameliorate the symptoms of BED; however, at present, there is one approved agent for the treatment of moderate to severe BED-lisdexamfetamine, a stimulant that was originally approved for the treatment of attention deficit hyperactivity disorder.

Binge eating disorder revisited: what’s new, what’s different, what’s next

“…A bibliometric search of the US National Library of Medicine's PubMed.gov resource using the text word query "binge eating disorder" revealed 2732 publications, of which 848 have appeared since the publication of the previous version of this review in December 2015. 4 New information is available on the epidemiology of BED in the USA and provides somewhat lower prevalence estimates than prior reports, 5,6 but the data continue to follow the same patterns when comparing the prevalence and course of BED with other eating disorders. This new analysis is from a nationally representative sample of US adults using data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III) comprising of over 36,000 respondents assessed with lay-administered diagnostic interviews.…”

Delay Discounting of Reward and Impulsivity in Eating Disorders: From Anorexia Nervosa to Binge Eating Disorder

“…Likewise, in the case of EDs associated with excess weight, the inability to resist the temptation of immediate rewards (i.e. unhealthy and palatable foods) is believed to be a detrimental influence on adherence to the dietary guidelines that commonly form part of BED treatment programs (Citrome, ).…”

Pilot study of the prevalence of binge eating disorder in non-alcoholic fatty liver disease patients

“…After an episode, patients may feel very guilty, depressed, or disgusted with themselves. Unlike other eating disorders, individuals with BED do not often partake in inappropriate compensatory behaviors such as inducing vomiting or starvation [ 7 ]. Over 40% of patients with BED are obese [ 8 ].…”