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Binge Eating Disorder

  • Eating an unusually large amount of food in one sitting and feeling a loss of control
  • Symptoms include eating rapidly or until uncomfortably full, feeling of disgust about overeating
  • Treatment includes dieting, nutritional, and behavioral approaches
  • Involves psychiatry, internal medicine

Overview

While everyone overeats once in a while, if you find yourself overeating at least once a week for at least three months, you may have binge eating disorder (BED). Binge eating is defined by two characteristics: eating an unusually large quantity of food during a short time period (two hours) and feeling a lack of control during each episode of overeating.

Unlike other eating disorders, BED is not necessarily associated with inappropriate weight control behaviors such as self-induced vomiting, laxative abuse, excessive exercise, or extreme dieting or food restriction.

BED affects almost 3 percent of adults in the United States. Population studies in the U.S. and around the world have found that more people struggle with BED than with the two other formal eating disorders (bulimia nervosa and anorexia nervosa) combined.

What are the symptoms of binge eating disorder?

The main symptoms of BED include recurrent binge-eating episodes and marked distress about the binge eating. The BED diagnosis (as outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, which is considered the official classification system of diagnoses in the U.S.) requires that binge-eating episodes are associated with at least three of these five features:

  • Eating until uncomfortably full
  • Eating a large amount of food while not even hungry
  • Eating more rapidly than usual
  • Eating alone because of embarrassment over the quantity eaten or eating behavior
  • Feeling disgusted, depressed or guilty after the overeating

But unlike those with bulimia nervosa, people with BED don’t typically purge their food when they overeat or use other extreme weight control methods. Also, unlike those with anorexia nervosa, they don’t severely restrict their food intake.

Many, but not all, people with BED have substantial body-image concerns; this symptom is not required to make the diagnosis. Roughly half of people with BED are overly concerned with their weight and shape, which is a “cognitive feature” characteristic of eating disorders. This refers to evaluating or defining one’s self-worth primarily by weight and shape, rather than by other personal attributes or achievements.

How does BED relate to other disorders?

Although BED is found among people across all categories of weight, it associated strongly with clinical obesity (body mass index of 30 or greater). BED is also linked to a heightened risk for a range of medical and metabolic problems, such as diabetes. It is associated with future weight gain, and the link to metabolic problems may be largely attributable to the excess weight.

Mood disorders, anxiety disorders, substance use disorders, and impulse control disorders are the most frequent co-occurring psychiatric diagnoses.

What are the risk factors for developing BED?

There appear to be genetic, environmental and individual factors that increase a person’s risk for developing BED. A family history of eating disorders, childhood obesity, a history of maltreatment and stressful life events, poor self-esteem, negative body image, and unhealthy diet practices are thought to be important risk factors.

Anorexia nervosa and bulimia nervosa typically start and peak in adolescence and early adulthood and disproportionately affect white females. In contrast, BED affects people of all ages, childhood through the senior years. It is common in both men and women, and occurs across different ethnic and racial groups at comparable rates.

How is BED diagnosed?

The diagnosis of BED is made based on an interview with a clinician who asks questions to learn whether the patient meets the DSM-5 criteria for BED. There is no laboratory or blood test for diagnosing this psychiatric disorder.

BED frequently goes unrecognized and undiagnosed. Key reasons include: 

  • People with BED may not realize they have a true medical problem that can be effectively treated
  • Many healthcare providers don’t assess patients for BED because of a lack of knowledge or perhaps even discomfort with asking their patients about eating and weight concerns
  • Some people with BED are embarrassed and ashamed about their eating behaviors, and are therefore hesitant to disclose them to family, friends or health-care professionals

When clinicians ask patients with BED specifically about eating and weight concerns in a sensitive and non-judgmental manner, the conversation is often met with relief and disclosure.

How is BED treated?

Several specific psychological and behavioral therapies are helpful for people with BED. These treatments can rapidly eliminate or significantly reduce binge eating. improve psychological functioning, and bring lasting change and improvement.

Cognitive behavioral therapy (CBT) is considered the most effective treatment for BED, with research demonstrating that it is the best-established and supported intervention for BED. Most patients with BED can benefit from 12 to 16 CBT sessions with a specialized therapist. Other specialized psychological treatments for BED include interpersonal psychotherapy(IPT) and dialectical behavior therapy. Both have been shown to be helpful to people with BED, with lasting effects. 

In 2014, the FDA approved the first medication for the short-term treatment of BED: Vyvanse (lisdexamfetamine), a central nervous system stimulant. Lisdexamfetamine is a drug that can significantly reduce binge eating over the short term, although its longer-term outcomes are not yet fully known. Important: This medication has a “black label warning,” indicating its potential for abuse, and a “limitation of use” warning emphasizing that it is not recommended for weight loss, as its efficacy and safety for obesity are not known.

Although dieting and nutritional approaches are of uncertain benefit, lifestyle behavioral weight loss treatments can reduce binge eating and weight. This approach helps patients establish goals around eating and exercise, and also helps them learn to identify and respond in healthier ways to triggers for binge-eating episodes.

What makes Yale Medicine's approach to treating BED unique?

Yale Medicine Psychiatry  is home to a program called POWER (Program for Obesity, Weight, and Eating Research) that offers ground-breaking treatment for BED. Directed by Carlos Grilo, PhD, a Professor of Psychiatry and Psychology at Yale Medicine, POWER offers state-of-the-art, evidence-based psychological and behavioral treatments as part of its research and training mission. 

Through POWER, eligible patients with BED can enroll in clinical trials providing access to new treatments. These trials are studying optimal doses and combinations of medications with psychological and behavioral therapies to learn which approaches work best and for whom. 

Yale Medicine also has comprehensive medical services with expertise to assess, manage and treat any associated medical and metabolic problems in patients with BED.