What is binge eating disorder? 

Everyone, at some point in their life, has overeaten. Whether it’s out to eat at a favorite restaurant, at a holiday meal, or a regular Friday night at home after a long week. However, for some individuals, excessive overeating feels out of control and is happening on a regular basis. This type of overconsumption is classified as binge eating disorder (BED) and can certainly feel embarrassing or scary to those who experience these recurrent episodes.  

Binge eating disorder affects an estimated 2.8 million adults in the United States and has been stated as the most common eating disorder in the U.S. The exact cause is unknown, as many factors contribute to eating habits. However, it is estimated that approximately 79% of those with binge eating disorder have been diagnosed with a psychiatric disorder (e.g., anxiety or mood disorders). And 49% of these individuals possess a history of two or more comorbid disorders (e.g., social phobia, post-traumatic stress disorder, body dysmorphic disorder, and alcohol or substance abuse).  

Diagnostic criteria

According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), binge eating disorder diagnosis consists of the following five criteria:  

1. Recurrent episodes, consisting of consuming an amount of food (within a two-hour period) that is larger than most individuals would eat under similar circumstances. This combines with the feeling of lack of control during food consumption. 
2. The episode is associated with three or more of the following: 
   • Eating faster than normal 
   • Eating until uncomfortable 
   • Eating a large amount despite not feeling physical hunger 
   • Eating alone due to embarrassment 
   • Feelings of guilt, depression, or disgust after overeating  
3. Interpersonal distress regarding binge eating. 
4. Episodes occur on average, at least one day per week for three months. 
5. Binge eating is not associated with compensatory behavior such as purging, fasting, or excessive exercise.  

Complications

The health consequences of binge eating disorder affect both physical and mental wellness. Complications can include: 

• Psychological complications: binge eating disorder can take an enormous emotional toll on those who suffer from this disorder, which can contribute to either the development or worsening symptoms of many mental health conditions. This can include depression, anxiety, substance abuse, bipolar disorder, antisocial behaviors, and overall poor quality of life.  
• Obesity: Not every individual with binge eating disorder is obese. However, if obesity is present, the risk of comorbidity rises. This can include a higher risk of heart disease, metabolic syndrome, joint problems, Type 2 diabetes, gastroesophageal reflux disease (GERD), osteoarthritis, certain types of cancer, fatty liver disease, and sleep disturbances.  

Treatment 

Psychotherapy is the most validated and effective treatment for binge eating disorder. The most common form of psychotherapy utilized is cognitive behavioral therapy. The more severe cases may benefit from pharmacological treatment as well, used in conjunction with psychotherapy. 

Cognitive behavior therapy: This is a type of talk therapy. It is structured and goal oriented, looking closely at thoughts and emotions, and discovering how those thoughts or emotions affect actions. With gaining a better understanding of this, therapists can then help patients strategize efforts to change unhelpful patterns. This may include recognizing distorted thoughts and re-evaluating them, using problem-solving skills to cope with difficult situations, or working to develop more confidence in an individual’s own abilities.  

Pharmacological treatment: There has only been one medication approved for binge eating disorder treatment by the United States Food and Drug Administration (FDA).  Lisdexamfetamine dimesylate (Vyvanse​Ⓡ​) was originally approved for attention deficit hyperactivity disorder (ADHD) and later approved for treatment of binge eating disorder. Due to the profile of side effects and risk of misuse with this medication, it may not be appropriate for all individuals. However, there are many other medications being utilized off-label in an effort to reduce binge episodes. Among these off-label medications, the most common prescribed are antidepressants. Selective serotonin reuptake inhibitors (SSRIs) such as sertraline, fluoxetine, fluvoxamine, escitalopram, or citalopram are often the first line pharmacotherapy. Antiepileptic medications are also utilized on occasion, such as topiramate and zonisamide.   

Summary 

Counseling from a dietitian can play a pivotal role in improving outcomes of treatment for binge eating disorder. Dietitians can help individuals organize and plan meals to create healthy patterns with less risk for binge episodes, assisting individuals in identifying triggers and strategies for coping. Also, due to binge eating disorder’s common association with psychological conditions, involvement of a mental health professional can be immensely beneficial. Treatment team members should be well-trained and aware of misconceptions and stigmas around binge eating disorder, ensuring all communication is done with care. Patients should feel supported and empowered by the treatment team, who is able to provide empathy, respect, and compassion throughout treatment sessions.  

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References: 

Berkman ND, Brownley KA, Peat CM, et al. Management and Outcomes of Binge-Eating Disorder [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015 Dec. (Comparative Effectiveness Reviews, No. 160.) Table 1, DSM-IV and DSM-5 diagnostic criteria for binge-eating disorder. Available from: https://www.ncbi.nlm.nih.gov/books/NBK338301/table/introduction.t1/ 

Iqbal A, Rehman A. Binge Eating Disorder. [Updated 2022 Oct 31]. In: statpearls [Internet]. Treasure Island (FL): statpearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551700/