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

Abstract

Binge eating disorder (BED) is the most common type of eating disorder. According to the most recent data available, the estimated lifetime prevalence of BED among US adults in the general population is 0.85% (men 0.42% and women 1.25%). Among psychiatric treatment populations, prevalence is several-fold higher. Although many people with BED are obese (BMI ≥ 30 kg/m2), roughly half are not. In the 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. BED often goes unrecognized and thus untreated; in one study, 344 of 22,387 (1.5%) survey respondents met DSM-5 criteria for BED, but only 11 out of the 344 had ever been diagnosed with BED by a health-care provider. Psychiatric comorbidities are very common, with most adults with BED also experiencing anxiety disorders, mood disorders, impulse control disorders, or substance use disorders, suggesting that clinicians have patients in their practice with unrecognized BED. Multiple neurobiological explanations have been suggested for BED, including dysregulation in reward center and impulse control circuitry. 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; however, access to such treatments may be limited because of local availability and/or cost, and these treatments generally lead to little to no weight loss, although successfully eliminating binge eating can protect against future weight gain. Routine medication treatments for anxiety and depression do not necessarily ameliorate the symptoms of BED, but there are approved and emerging medication options, lisdexamfetamine and dasotraline, respectively, that specifically address the core drivers behind binge eating, namely obsessive thoughts and compulsive behaviors regarding food, resulting in marked decreases in binge eating behaviors as well as weight loss.

General impulsivity in binge-eating disorder

“…Pharmacological agents that treat BED and reduce impulsivity symptoms, including lisdexamfetamine dimesylate (LDX), may be especially effective in individuals with difficulties related to general impulsivity. 4,69,70 Treatment trials for BED may benefit from investigations of general impulsivity and its effect on treatment outcomes.…”

“…2 BED is characterized by a recurrent pattern of binge eating (i.e., consuming large quantities of food in a short period of time while experiencing a subjective sense of loss of control) associated with marked distress and without weight-compensatory behaviors. 3,4 One factor thought to contribute to the development and maintenance of binge-eating psychopathology is impulsivity, a multidimensional construct that reflects a propensity to engage in increased reward-seeking behavior and poor reward-related decision-making. 5 Impulsivity differs from compulsivity, 6 although obsessions/compulsions about food are associated with frequency of binge eating and BED severity.…”

Unexpectedly High Prevalence of Breakfast Skipping in Low Body-Weight Middle-Aged Men: Results of the Kanagawa Investigation of Total Checkup Data from the National Data Base-7 (KITCHEN-7)

“…Meanwhile, appetite-regulating substances including leptin, neuropeptide Y, ghrelin, peptide YY, and orexin may contribute to the sex-related differences in the association between BS and BMI, as several human and animal studies have reported the possibility of sex-related differences in these substances [ 28 , 29 , 30 , 31 ]. Consistently, eating disorders such as anorexia nervosa and binge eating disorder have been reported to be more prevalent in women than in men [ 32 , 33 ]. However, it is unknown whether BS in low-body-weight men is attributable to such eating disorders or impaired mental health, although BS may be associated with depressive symptoms and mood disorders [ 34 , 35 , 36 ].…”

Can we change binge eating behaviour by interventions addressing food-related impulsivity? A systematic review

“…Cognitive-behavioural therapy (CBT), interpersonal therapy (IPT), and dialectical behaviour therapy (DBT) are considered first-line treatments for individuals with BN and BED [25][26][27]. However, meta-analyses and review studies indicate that available conventional treatments have difficulties in decreasing binge eating behaviour, with up to 50% of patients not benefiting from these treatments and remaining symptomatic [27,28]. One reason for this might be that although theoretical models and research concerning binge eating behaviour emphasize impulsivity, the translation of this evidence into treatment is still limited.…”