Binge eating

Last updated
Binge eating
Specialty Psychiatry
Symptoms Eating addiction

Binge eating is a pattern of disordered eating which consists of episodes of uncontrollable eating. It is a common symptom of eating disorders such as binge eating disorder and bulimia nervosa. During such binges, a person rapidly consumes an excessive quantity of food. A diagnosis of binge eating is associated with feelings of loss of control. [1] Binge eating disorder is also linked with being overweight and obesity. [2]

Contents

Diagnosis

The DSM-5 includes a disorder diagnosis criterion for Binge Eating Disorder (BED). It is as follows: [3]

Warning signs

Typical warning signs of binge eating disorder include the disappearance of a large quantity of food in a relatively short period of time. A person who may be experiencing binge eating disorder may appear to be uncomfortable when eating around others or in public. [4] A person may develop new and extreme eating patterns that they have never done before. These might include diets that cut out certain food groups completely such as a no dairy or no carb diet. Binge eating can begin after a first attempt at dieting. [5] They might also steal or hoard food in unusual places. [4] A person may be experiencing fluctuations in their weight. In addition, they may have feelings of disgust, depression, or guilt about overeating. [4] Another possible warning sign of binge eating is that a person may be obsessed with their body image or weight. [6]

Furthermore, patients who binge eat may also engage in other self-destructing behaviours like suicide attempts, drug use, shop-lifting, and drinking too much alcohol. [7] [8] [9] [10] The onset of binge eating without dieting is linked to a higher risk of mental health issues and a younger age of onset. [5] BED patients can experience comorbid psychiatric instability. [5]

Causes

There are no direct causes of binge eating; however, long-term dieting, psychological issues and an obsession with body image have been linked to binge eating. There are multiple factors that increase a person's risk of developing binge eating disorder. Family history could play a role if that person had a family member who was affected by binge eating. Said person may not have a supportive or friendly home environment, and they have a hard time expressing their problems with BED. Having a history of going on extreme diets may cause an urge to binge eat. Psychological issues such as feeling negatively about oneself or the way they look may trigger a binge. [11]

Weight stigma has also been found to predict binge eating, [12] highlighting the importance of weight inclusive approaches to binge eating disorder that do not exercerbate this potential cause.

Health risks

There are several physical, emotional, and social health risks when associated with binge eating disorder. These risks include depression, anxiety, and heart disease. [13]

One study found that people with obesity who experience binge eating have a higher body mass index, and higher levels of depression and stress than those who did not have with binge eating disorder [14] Exposure to two major categories of risk factors—those that raise the risk for obesity and those that raise the risk for psychiatric disorders in general—can be associated with binge eating disorder. [15]

Effects

Typically, the eating is done rapidly, and a person will feel emotionally numb and unable to stop eating. [16] Most people who have eating binges try to hide this behavior from others, and often feel ashamed about being overweight or depressed about their overeating. Although people who do not have any eating disorder may occasionally experience episodes of overeating, frequent binge eating is often a symptom of an eating disorder.[ citation needed ]

BED is characterized by uncontrollable, excessive eating, followed by feelings of shame and guilt. Unlike those with bulimia, those with BED symptoms typically do not purge their food, fast, or excessively exercise to compensate for binges. Additionally, these individuals tend to diet more often, enroll in weight-control programs and have a history of family obesity. [17] However, many who have bulimia also have binge-eating disorder.[ citation needed ]

Along with the social and physical health that is affected when suffering from BED, there are psychiatric disorders that are often linked to BED. Some of them being but are not limited to: depression, bipolar disorder, anxiety disorder, substance abuse/use disorder.[ citation needed ]

Treatments

Current treatments for binge eating disorder mainly consist of psychological therapies, such as Cognitive Behavioural Therapy (CBT), [18] Interpersonal Psychotherapy (IPT), [19] and Dialectical Behavioural Therapy (DBT). [20] A study conducted on the long term efficacy of psychological treatments for binge eating showed that both cognitive behavioral therapy (CBT) and group interpersonal psychotherapy (IPT) effectively treat binge eating disorder, with 64.4% of patients completely recovering from binge eating. [21]

Lisdexamfetamine dimesylate, also known as Vyvanse, is the only medication approved by the Food and Drug Administration (FDA) for the treatment of moderate-to-severe binge eating disorder in adults as of 2024. [22] [23] [24] However, some studies have called into question its effectiveness for this indication. [25]

History

APA DSM

The American Psychiatric Association mentioned and listed binge eating under the listed criteria and features of bulimia in the Diagnostic and Statistical Manual of Mental Disorders (DSM) - 3 in 1987. By including binge eating in the DSM-3, even if not on its own as a separate eating disorder, they brought awareness to the disorder and gave it mental disorder legitimacy. This allowed for people to receive the appropriate treatment for binge eating and for their disorder to be legitimized.

Drug therapy

In January 2015, the Food and Drug Administration (FDA) approved lisdexamfetamine dimesylate (Vyvanse), the first medication indicated for the treatment of moderate-to-severe binge eating disorder. [22] [23] [24]

Men with binge eating

Men with binge eating often face unique barriers to seeking treatment due to socio-cultural expectations surrounding masculinity. After men compare their bodies to the culturally constructed masculine ideals, they often develop heightened concerns about their own body image and internalize the belief that their bodies should be muscular, lean, and strong, developing unhealthy behaviors like binge eating or using fad diets. [26] [27] Many men hesitate to reach out for help out of fear of appearing weak, 'less like a man' or even homosexual. [28] [29] The pervasive stereotype that eating disorders primarily affect women has contributed to feelings of shame and isolation among men who are affected by these disorders. This gender-based stigma surrounding eating disorders and strongly feminine branding of eating disorder treatment centers create a significant barrier to men's willingness to reach out for support. [30] [31] [32] [33] Men are more likely to partake in compulsive or excessive exercising as a compensation to highly calorific diets, leading to body dysmorphia. [34]

See also

Related Research Articles

An eating disorder is a mental disorder defined by abnormal eating behaviors that adversely affect a person's physical or mental health. Types of eating disorders include binge eating disorder, where the patient eats a large amount in a short period of time; anorexia nervosa, where the person has an intense fear of gaining weight and restricts food or overexercises to manage this fear; bulimia nervosa, where individuals eat a large quantity (binging) then try to rid themselves of the food (purging); pica, where the patient eats non-food items; rumination syndrome, where the patient regurgitates undigested or minimally digested food; avoidant/restrictive food intake disorder (ARFID), where people have a reduced or selective food intake due to some psychological reasons; and a group of other specified feeding or eating disorders. Anxiety disorders, depression and substance abuse are common among people with eating disorders. These disorders do not include obesity. People often experience comorbidity between an eating disorder and OCD. It is estimated 20–60% of patients with an ED have a history of OCD.

<span class="mw-page-title-main">Bulimia nervosa</span> Type of eating disorder

Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging or fasting, and excessive concern with body shape and weight. This activity aims to expel the body of calories eaten from the binging phase of the process. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives.

<span class="mw-page-title-main">Appetite</span> Desire to eat food

Appetite is the desire to eat food items, usually due to hunger. Appealing foods can stimulate appetite even when hunger is absent, although appetite can be greatly reduced by satiety. Appetite exists in all higher life-forms, and serves to regulate adequate energy intake to maintain metabolic needs. It is regulated by a close interplay between the digestive tract, adipose tissue and the brain. Appetite has a relationship with every individual's behavior. Appetitive behaviour also known as approach behaviour, and consummatory behaviour, are the only processes that involve energy intake, whereas all other behaviours affect the release of energy. When stressed, appetite levels may increase and result in an increase of food intake. Decreased desire to eat is termed anorexia, while polyphagia is increased eating. Dysregulation of appetite contributes to anorexia nervosa, bulimia nervosa, cachexia, overeating, and binge eating disorder.

Binge eating disorder (BED) is an eating disorder characterized by frequent and recurrent binge eating episodes with associated negative psychological and social problems, but without the compensatory behaviors common to bulimia nervosa, OSFED, or the binge-purge subtype of anorexia nervosa.

Overeating occurs when an individual consumes more calories in relation to the energy that is expended via physical activity or expelled via excretion, leading to weight gain and often obesity. Overeating is the defining characteristic of binge eating disorder.

A food addiction or eating addiction is any behavioral addiction characterized primarily by the compulsive consumption of palatable and hyperpalatable food items. Such foods often have high sugar, fat, and salt contents, and markedly activate the reward system in humans and other animals. Those with eating addictions often overconsume such foods despite the adverse consequences associated with their overconsumption.

William Stewart Agras is an American psychiatrist and psychotherapist of British origin, research psychiatrist and Emeritus (Active) Professor of Psychiatry and Behavioral Science at Stanford University. He normally goes by Stewart Agras.

Night eating syndrome (NES) is an eating disorder, characterized by a delayed circadian pattern of food intake. Although there is some degree of comorbidity with binge eating disorder, it differs from binge eating in that the amount of food consumed in the night is not necessarily objectively large nor is a loss of control over food intake required. It was originally described by Albert Stunkard in 1955 and is currently included in the other specified feeding or eating disorder category of the DSM-5. Research diagnostic criteria have been proposed and include evening hyperphagia and/or nocturnal awakening and ingestion of food two or more times per week. The person must have awareness of the night eating to differentiate it from the parasomnia sleep-related eating disorder (SRED). Three of five associated symptoms must also be present: lack of appetite in the morning, urges to eat at night, belief that one must eat in order to fall back to sleep at night, depressed mood, and/or difficulty sleeping.

<span class="mw-page-title-main">Lisdexamfetamine</span> Central nervous system stimulant prodrug

Lisdexamfetamine, sold under the brand names Vyvanse and Elvanse among others, is a stimulant medication that is used to treat attention deficit hyperactivity disorder (ADHD) in children and adults and for moderate-to-severe binge eating disorder in adults. Lisdexamfetamine is taken by mouth. Its effects generally begin within two hours and last for up to 14 hours. In the United Kingdom, it is usually less preferred to methylphenidate for the treatment of children.

The Eating Attitudes Test, created by David Garner, is a widely used 26-item, standardized self-reported questionnaire of symptoms and concerns characteristic of eating disorders. The EAT is useful in assessing "eating disorder risk" in high school, college and other special risk samples such as athletes. EAT has been extremely effective in screening for anorexia nervosa in many populations.

Diabulimia, also known as ED-DMT1 in the US or T1ED in the UK, is an eating disorder in which people with type 1 diabetes deliberately give themselves less insulin than they need or stop taking it altogether for the purpose of weight loss. Diabulimia is not recognized as a formal psychiatric diagnosis in the DSM-5. Because of this, some in the medical or psychiatric communities use the phrases "disturbed eating behavior" or "disordered eating behavior" and disordered eating (DE) are quite common in medical and psychiatric literature addressing patients who have type 1 diabetes and manipulate insulin doses to control weight along with exhibiting bulimic behavior.

Purging disorder is an eating disorder characterized by the DSM-5 as self-induced vomiting, or misuse of laxatives, diuretics, or enemas to forcefully evacuate matter from the body. Purging disorder differs from bulimia nervosa (BN) because individuals do not consume a large amount of food before they purge. In current diagnostic systems, purging disorder is a form of other specified feeding or eating disorder. Research indicates that purging disorder, while not rare, is not as commonly found as anorexia nervosa or bulimia nervosa. This syndrome is associated with clinically significant levels of distress, and that it appears to be distinct from bulimia nervosa on measures of hunger and ability to control food intake. Some of the signs of purging disorder are frequent trips to the bathroom directly after a meal, frequent use of laxatives, and obsession over one's appearance and weight. Other signs include swollen cheeks, popped blood vessels in the eyes, and clear teeth which are all signs of excessive vomiting.

The Eating Disorder Inventory (EDI) is a self-report questionnaire used to assess the presence of eating disorders, (a) anorexia nervosa both restricting and binge-eating/purging type; (b) bulimia nervosa; and (c) eating disorder not otherwise specified including binge eating disorder. The original questionnaire consisted of 64 questions, divided into eight subscales. It was created in 1984 by David M. Garner and others. There have been two subsequent revisions by Garner: the Eating Disorder Inventory-2 (EDI-2) and the Eating Disorder Inventory-3 (EDI-3).

<span class="mw-page-title-main">Anorexia nervosa</span> Type of eating disorder

Anorexia nervosa (AN), often referred to simply as anorexia, is an eating disorder characterized by food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin.

Cognitive behavioral therapy (CBT) is derived from both the cognitive and behavioral schools of psychology and focuses on the alteration of thoughts and actions with the goal of treating various disorders. The cognitive behavioral treatment of eating disorders emphasizes on the minimization of negative thoughts about body image and the act of eating, and attempts to alter negative and harmful behaviors that are involved in and perpetuate eating disorders. It also encourages the ability to tolerate negative thoughts and feelings as well as the ability to think about food and body perception in a multi-dimensional way. The emphasis is not only placed on altering cognition, but also on tangible practices like making goals and being rewarded for meeting those goals. CBT is a "time-limited and focused approach" which means that it is important for the patients of this type of therapy to have particular issues that they want to address when they begin treatment. CBT has also proven to be one of the most effective treatments for eating disorders.

Drunkorexia is a colloquialism for anorexia or bulimia combined with an alcohol use disorder. The term is generally used to denote the utilization of extreme weight control methods to compensate for planned binge drinking. Research on the combination of an eating disorder and binge drinking has primarily focused on college-aged women, though the phenomenon has also been noted among young men. Studies suggest that individuals engage in this combination of self-imposed malnutrition and binge drinking to avoid weight gain from alcohol, to save money for purchasing alcohol, and to facilitate alcohol intoxication.

Emotional eating, also known as stress eating and emotional overeating, is defined as the "propensity to eat in response to positive and negative emotions". While the term commonly refers to eating as a means of coping with negative emotions, it sometimes include eating for positive emotions, such as overeating when celebrating an event or to enhance an already good mood.

Christopher James Alfred Granville Fairburn is a British psychiatrist and researcher. He is Emeritus Professor of Psychiatry at the University of Oxford. He is known for his research on the development, evaluation and dissemination of psychological treatments, especially for eating disorders.

Paul E. Garfinkel is a Canadian psychiatrist, researcher and an academic leader. He is a professor at the University of Toronto and a staff psychiatrist at Centre for Addiction and Mental Health (CAMH).

Body image disturbance (BID) is a common symptom in patients with eating disorders and is characterized by an altered perception of one's own body.

References

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