Binge eating disorder in adults
Binge eating disorder is an eating disorder characterized by recurrent episodes of compulsive eating or binge eating, along with food-related anxiety, eating in secret, or eating when not hungry. It is often referred to as BED ( Binge Eating Disorder ).
Binge eating disorder is the most prevalent eating disorder (affecting 3% of the adult population in the United States at some point in their lives), and is more common in women (3.5%) than in men (2%) and in obese individuals (5 to 30%), especially those with morbid obesity. It is also the most common eating disorder in men. It typically begins in late adolescence or young adulthood and persists into later life.
This disorder was described by Albert Stunkard in the 1950s, but it was not included in the classifications of mental disorders until the 1980s. It was finally included as a diagnosis in its own right in the DSM-5 classification system in 2013.
We speak of a disorder when recurrent binge eating occurs.
A binge-eating episode is characterized by:
- Intake, in a given period of time, of an amount of food that is clearly greater than what most people would ingest in a similar period under similar circumstances.
- Feeling of lack of control over what is ingested during the episode.
Binge eating episodes are associated with intense emotional distress and occur at least once a week for three months. They are characterized by:
- Eating much faster than normal.
- Eat until you feel uncomfortably full.
- Eating large amounts of food when you are not hungry.
- Eating only in secret, due to the shame felt about the amount consumed.
- Feeling disgusted with oneself, depressed, or very ashamed.
Appetite in eating disorders
Binge eating is an eating behavior that also appears in other eating disorders characterized by impulsive eating, such as bulimia nervosa or binge-eating anorexia nervosa . However, unlike these eating disorders, binge eating disorder is not characterized by recurrent inappropriate compensatory behaviors, such as food restriction, fasting, or purging behaviors to eliminate ingested calories.
To understand binge eating disorder, it's crucial to recognize that it's not solely characterized by consuming large quantities of food. Identifying and understanding the emotional component associated with these episodes—both the emotional distress and the loss of control during the binge—is essential for incorporating these aspects into therapeutic goals and achieving positive outcomes.
Binge eating disorder is frequently associated with obesity (30-45% of cases) and related metabolic disorders such as type 2 diabetes, as well as its early onset and a worse prognosis. Given its close relationship with obesity, morbid obesity, and its serious health repercussions, it is essential to deepen our understanding and treatment of binge eating disorder.
It is also associated with poorer social functioning, chronic pain, and other psychiatric conditions such as attention deficit hyperactivity disorder, impulse control disorders (substance abuse, compulsive buying, etc.), sleep disorders, major depression, and anxiety disorders.
Many questions remain unanswered regarding the neurobiological basis of binge eating disorder. Following numerous studies in neuroimaging, genetics, neuropsychology, and animal research, binge eating disorder is conceptualized as an impulsive/compulsive disorder, characterized by impaired reward sensitivity and attentional biases related to food. Neuroimaging studies have revealed alterations in cortico-striatal circuits similar to those identified in substance abuse disorders. Compulsive eating behaviors have been associated with alterations in the neurotransmitter networks of the dopaminergic and opioid systems. Binge eating disorder has also been linked to maladaptation of the cortico-striatal circuit, which regulates motivation and impulse control.
How is binge eating disorder treated?
The treatment for binge eating disorder is aimed at reducing the frequency of binge eating, altering food cognitions, improving weight and metabolic health, and regulating mood.
The therapeutic approach is based on psychological treatment, psychopharmacological treatment, and a combination of both . Clinical guidelines based on scientific evidence (APA, NICE, etc.) emphasize the use of cognitive behavioral therapy and selective serotonin reuptake inhibitor (SSRI) antidepressants such as fluoxetine, or antiepileptic drugs such as topiramate as second-line treatment. Some approaches recommend therapy focused solely on psychopharmacological treatment or solely on psychological treatment, while others recommend a team approach involving psychiatrists, psychologists, dietitians, and social workers, using cognitive behavioral therapy as the core therapy and psychopharmacological treatment as a support.
Among the various approaches to psychotherapy, cognitive-behavioral therapy, interpersonal therapy, and dialectical behavior therapy stand out.
- Cognitive behavioral therapy is aimed at regulating eating behavior patterns and redirecting thoughts related to food.
- Interpersonal therapy is sometimes also used to resolve interpersonal relationship difficulties that contribute to the development of binge eating disorder.
- Dialectical behavior therapy is aimed at identifying triggers for binge eating related to emotions and learning strategies to manage and tolerate these emotions without binge eating.
Psychopharmacological treatments are aimed at regulating mood, reducing impulsivity and appetite, and decreasing episodes of compulsive eating.
- The strongest scientific evidence has been found for selective serotonin reuptake inhibitor (SSRI) antidepressants, such as fluoxetine and sertraline. These drugs are associated with improved emotional well-being, decreased appetite, and a reduction in the frequency of binge-eating episodes.
- Second-line treatments include antiepileptic drugs such as topiramate and zonisamide, which reduce impulsivity and promote weight loss.
- Central nervous system stimulant drugs, such as lisdexamfetamine, are also used to reduce symptoms of impulsivity, inattention, and binge eating episodes.
Most studies show that short-term treatments are effective in reducing binge eating. Long-term studies are needed to determine the effectiveness of these treatments in relation to compulsive eating, depression, and obesity. Given the high prevalence of binge eating disorder and its impact on physical and psychological health, it is important to increase awareness about this eating disorder and strengthen prevention programs.
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