Binge-eating Disorder

Overview

Binge-eating (BED) disorder is a serious eating disorder in which you frequently consume unusually large amounts of food and feel unable to stop eating.

Almost everyone overeats on occasion, such as having seconds or thirds of a holiday meal. But for some people, excessive overeating that feels out of control and becomes a regular occurrence crosses the line to binge-eating disorder.

When you have binge-eating disorder, you may be embarrassed about overeating and vow to stop. But you feel such a compulsion that you can’t resist the urges and continue binge eating.

Symptoms

Most people with binge-eating disorder are overweight or obese, but you may be at a normal weight. Behavioral and emotional signs and symptoms of binge-eating disorder include:

• Eating unusually large amounts of food in a specific amount of time, such as over a two-hour period
• Feeling that your eating behavior is out of control
• Eating even when you’re full or not hungry
• Eating rapidly during binge episodes
• Eating until you’re uncomfortably full
• Frequently eating alone or in secret
• Feeling depressed, disgusted, ashamed, guilty or upset about your eating
• Frequently dieting, possibly without weight loss

Unlike a person with bulimia, after a binge, you don’t regularly compensate for extra calories eaten by vomiting, using laxatives or exercising excessively. You may try to diet or eat normal meals. But restricting your diet may simply lead to more binge eating.

The severity of binge-eating disorder is determined by how often episodes of bingeing occur during a week.

When to see a doctor

If you have any symptoms of binge-eating disorder, seek medical help as soon as possible. Binge-eating problems can vary in their course from short-lived to recurrent or they may persist for years if left untreated.

Talk to your medical care provider or a mental health professional about your binge-eating symptoms and feelings. If you’re reluctant to seek treatment, talk to someone you trust about what you’re going through. A friend, loved one, teacher or faith leader can help you take the first steps to successful treatment of binge-eating disorder.

Causes

Bulimia Causes and Risk Factors

Research suggests that a mixture of certain personality traits, emotions, and thinking patterns, as well as biological and environmental factors, might be responsible.

Researchers believe this eating disorder may begin with dissatisfaction with your body and extreme concern with your size and shape. Usually, you have low self-esteem and fear becoming overweight. The fact that bulimia tends to run in families also suggests that you might inherit a risk for the disorder.

Other risk factors include:

• Genetics. People with BED may have increased sensitivity to dopamine, a chemical in the brain that’s responsible for feelings of reward and pleasure. There is also strong evidence that the disorder is inherited.
• Gender. BED is more common in women than in men. In the United States, 3.6% of women experience BED at some point in their lives, compared with 2.0% of men. This may be due to underlying biological factors.
• Changes in the brain. There are indications that people with BED may have changes in brain structure that result in a heightened response to food and less self-control.
• Body size. Almost 50% of people with BED have obesity, and 25–50% of patients seeking weight loss surgery meet the criteria for BED. Weight problems may be both a cause and result of the disorder.
• Body image. People with BED often have a very negative body image. Body dissatisfaction, dieting, and overeating contribute to the development of the disorder.
• Binge eating. Those affected often report a history of binge eating as the first symptom of the disorder. This includes binge eating in childhood and the teenage years.
• Emotional trauma. Stressful life events, such as abuse, death, separation from a family member, or a car accident, are risk factors. Childhood bullying due to weight may also contribute
• Other psychological conditions. Almost 80% of people with BED have at least one other psychological disorder, such as phobias, depression, post-traumatic stress disorder (PTSD) , bipolar disorder, anxiety, or substance abuse.

An episode of binge eating can be triggered by stress, dieting, negative feelings relating to body weight or body shape, the availability of food, or boredom 

Risk factors

Binge-eating disorder is more common in women than in men. Although people of any age can have binge-eating disorder, it often begins in the late teens or early 20s.

Factors that can increase your risk of developing binge-eating disorder include:

• Family history. You’re much more likely to have an eating disorder if your parents or siblings have (or had) an eating disorder. This may indicate that inherited genes increase the risk of developing an eating disorder.
• Dieting. Many people with binge-eating disorder have a history of dieting. Dieting or restricting calories during the day may trigger an urge to binge eat, especially if you have symptoms of depression.
• Psychological issues. Many people who have binge-eating disorder feel negatively about themselves and their skills and accomplishments. Triggers for bingeing can include stress, poor body self-image and the availability of preferred binge foods.

Complications

You may develop psychological and physical problems related to binge eating.

Complications that may be caused by binge-eating disorder include:

• Poor quality of life
• Problems functioning at work, with your personal life or in social situations
• Social isolation
• Obesity
• Medical conditions related to obesity, such as joint problems, heart disease, type 2 diabetes, gastroesophageal reflux disease (GERD) and some sleep-related breathing disorders

Psychiatric disorders that are often linked with binge-eating disorder include:

• Depression
• Bipolar disorder
• Anxiety
• Substance use disorders

Prevention

Although there’s no sure way to prevent binge-eating disorder, if you have symptoms of binge eating, seek professional help. Your medical care provider can advise you on where to get help.

If you think a friend or loved one has a binge-eating problem, steer her or him toward healthier behavior and professional treatment before the situation worsens. If you have a child:

• Foster and reinforce a healthy body image, regardless of body shape or size
• Discuss any concerns with your child’s primary care provider, who may be in a good position to identify early indicators of an eating disorder and help prevent its development

treatment

The treatment plan for BED depends on the causes and severity of the eating disorder, as well as individual goals.

Treatment may target binge eating behaviors, excess weight, body image, mental health issues, or a combination of these.

Therapy options include cognitive behavioral therapy, interpersonal psychotherapy, dialectical behavior therapy, weight loss therapy, and medication. These may be carried out on a one-to-one basis, in a group setting, or in a self-help format.

In some people, just one type of therapy may be required, while others may need to try different combinations until they find the right fit.

A medical or mental health professional can provide advice on selecting an individual treatment plan.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) for BED focuses on analyzing the relationships between negative thoughts, feelings, and behaviors related to eating, body shape, and weight.

Once the causes of negative emotions and patterns have been identified, strategies can be developed to help people change them.

Specific interventions include setting goals, self-monitoring, achieving regular meal patterns, changing thoughts about self and weight, and encouraging healthy weight-control habits.

Therapist-led CBT has been demonstrated to be the most effective treatment for people with BED. One study found that after 20 sessions of CBT, 79% of participants were no longer binge eating, with 59% of them still successful after one year.

Alternatively, guided self-help CBT is another option. In this format, participants are usually given a manual to work through on their own, along with the opportunity to attend some additional meetings with a therapist to help guide them and set goals.

Interpersonal psychotherapy

Interpersonal psychotherapy (IPT) is based on the idea that binge eating is a coping mechanism for unresolved personal problems such as grief, relationship conflicts, significant life changes, or underlying social problems.

The goal is to identify the specific problem linked to the negative eating behavior, acknowledge it, and then make constructive changes over 12–16 weeks.

Therapy may either be in a group format or on a one-to-one basis with a trained therapist, and it may sometimes be combined with CBT.

There is strong evidence that this type of therapy has both short- and long-term positive effects on reducing binge eating behavior. It is the only other therapy with long-term outcomes as good as CBT.

It may be particularly effective for people with more severe forms of binge eating and those with lower self-esteem.                                  

Dialectical behavior therapy

 Dialectical behavior therapy (DBT) views binge eating as an emotional reaction to negative experiences that the person has no other way of coping with.

It teaches people to regulate their emotional responses so that they can cope with negative situations in daily life without binging.

The four key areas of treatment in DBT are mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

A study including 44 women with BED who underwent DBT showed that 89% of them stopped binge eating by the end of therapy, although this dropped to 56% by the 6-month follow-up.

However, there is limited information on the long-term effectiveness of DBT and how it compares with CBT and IPT.

While research on this treatment is promising, more studies are needed to determine if it could be applied to all people with BED.

Weight loss therapy

Behavioral weight loss therapy aims to help people lose weight, which may reduce binge eating behavior by improving self-esteem and body image.

The intent is to make gradual healthy lifestyle changes   in regards to diet and exercise, as well as monitor food intake and thoughts about food throughout the day. Weight loss of about 1 pound (0.5 kg) per week is expected.

While weight loss therapy may help improve body image and reduce weight and the health risks associated with obesity, it has not been shown to be as effective as CBT or IPT at stopping binge eating.

As with regular weight loss treatment for obesity, behavioral weight loss therapy has been shown to help people achieve only short-term, moderate weight loss.

However, it may still be a good option for people who were not successful with other therapies or are primarily

Medications

Several medications have been found to treat binge eating and are often cheaper and faster than traditional therapy.

However, no current medications are as effective at treating BED as behavioral therapies.

Available treatments include antiepileptic, antidepressants drugs like topiramate, and drugs traditionally used for hyperactive disorders, such as lisdexamfetamine.

Research has found that medications have an advantage over a placebo for the short-term reduction of binge eating. Medications have been shown to be 48.7% effective, while placebos have been shown to be 28.5% effective.

They may also reduce appetite, obsessions, compulsions, and symptoms of depression.

Although these effects sound promising, most studies have been conducted over short periods, so data on the long-term effects is still needed.

In addition, side effects of treatment may including headaches, stomach problems, sleep disturbances, increased blood pressure, and anxiety.

Because many people with BED have other mental health conditions, such as anxiety and depression, they may also receive additional medications to treat these.