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Binge Eating Disorder: What You Need to Know

Binge Eating Disorder: What You Need to Know

  • Nature of the Problem: Up to one-quarter of obese patients may have binge eating disorder (BED)(1); compared to obese patients without BED, obese patients with BED may have: Greater adiposity; earlier onset of overweight, using dieting; lower self-esteem; more medical/psychiatric morbidity (depression, anxiety, personality disorders).(2)
  • DSM-V Definitions of binge eating: Much more severe, less common than overeating; significant physical/psychological issues; formal diagnosis for the first time in the DSM-5(3); DSM-5 criteria for BED include: • “Recurring episodes of eating significantly more food in a short period of time than most people would eat under similar circumstances, with episodes marked by a feeling of lack of self-control” • Eating too quickly even when not hungry; • Feeling guilty, embarrassed, or disgusted; eating alone to hide the behavior • Associated with marked distress • Happens, on average, at least once a week for 3 months.
  • Obese patients may also be at risk for: • Night-eating syndrome: eating after awakening from sleep or excessive food intake after the evening meal; subthreshold bulimia nervosa; atypical anorexia nervosa.
  • Only about one-third of patients with eating disorders are ever asked about their problems with food, so screening is essential.(4) Gold standard = structured interviews: Eating Disorder Examination (EDE)(5); Structured Clinical Interview for DSM-IV19 (SCID-IV).(6) Drawbacks: Requires time-intensive training and can only be given by one person at a time.
  • Self-report questionnaires may have an advantage over structured interviews: Faster scoring; no intensive training required; patients may report higher rate of eating disorder symptoms on self-report questionnaires, due to feelings of shame or guilt experienced in face to face interviews; studies have suggested good agreement between expert and self-assessments of BED in obese patients.(4)
  • EDE questionnaire (EDE-Q): Relies on self-report, may generate higher scores than EDE interview(7); Questionnaire on Eating and Weight Patterns-Revised (QEWP-R): Questions specific eating disorders, dieting, and weight history(8); Binge Eating Scale: Assesses severity(9); Eating Disorder Inventory: Looks at eight aspects of psychopathology in eating disorders(10); Three Factor Eating Questionnaire (TFEQ): Measures dietary restraint, disinhibition and hunger(11) Food-Craving Inventory: Measures general and specific cravings.(12)
  • Psychological treatment approaches: Cognitive-Behavioral Therapy (CBT): Behavioral intervention of choice; Guided Self-help Programs: Mindfulness training, self-monitoring of food consumption, education, problem-solving strategies, limit strict dieting, relapse-prevention strategies (limited evidence); Weight loss strategies.(13)
  • Pharmacologic approaches: Antidepressants: SSRIs (citalopram, escitalopram, fluoxetine, fluvoxamine, sertraline); SNRIs (duloxetine, atomoxetine); bupropion; TCAs: imipramine, desipramine; Antiepileptics: Topiramate, lamotrigine, zonisamide; Appetite Suppressants: Sibutramine (Meridia).(14)
  • Vyvanse (lisdexamfetamine dimesylate): First drug approved by the FDA in February 2015 for the treatment of moderate to severe BED (also approved in 2007 for ADHD); sympathomimetic that is also associated with weight loss. According to a recent review, topiramate and Vyvanse may have the most “favorable” profiles for controlling BED symptoms and promoting weight loss. A tool for screening adults that may have BED is available at the Vyvanse website: Adult Binge Eating Disorder Patient Screener
  • Common among obese: Up to one-quarter may have BED. Characterized by marked distress, eating significantly more food in a short period of time than most people, feeling out of control, eating too quickly even when not hungry, feeling guilty, embarrassed, or disgusted, and eating alone. Episodes occur at 1/week for 3 months. Gold standard for BED screening is structured interviews, though many self-report questionnaires exist and may have advantages over formal interviews. CBT is the behavioral intervention of choice. Topiramate and Vyvanse may have the most “favorable” pharmacologic profiles for controlling BED symptoms and promoting weight loss.

♦ Binge eating disorder (BED) is the most common eating disorder in the United States. Lifetime prevalence in adult women is approximately 3.5% and in adult men, 2.0%. Prevalence among adolescents is an estimated 1.6 %.

♦ Up to one-quarter of obese patients may have BED.

♦ Hallmark behavior of BED is frequent episodes of binge eating associated with a feeling of loss of control. Emotional distress afterward is significant. Comorbid depression and other psychiatric conditions are common.

♦ Screening for BED and other eating disorders is essential but also challenging because of the shame associated with the behaviors.

♦ Cognitive-behavioral therapy is considered the gold standard of psychological treatment.  

♦ There is one FDA-approved agent for BED; a wide range of antidepressants are used with variable success.

Click through the slides above for more details on the disorder and its management.

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References

  1. Hsu LKG, Mulliken B, McDonagh B, et al. Binge eating disorder in extreme obesity. Int J Eat Disord. 2002;26:1398-1403.
  1. Bulik CM, Sullivan PF, Kendler KS. Medical and psychiatric morbidity in obese women with and without binge eating. Int J Eat Disord. 2002;32:72-78.
  2. American Psychiatric Publishing. Food and Eating Disorders. http://www.dsm5.org/documents/eating%20disorders%20fact%20sheet.pdf. Accessed April 10, 2015.
  3. Hartmann AS, Gorman MJ, Sogg S, et al. Screening for DSM-5 Other Specified Feeding or Eating Disorder in a Weight-Loss Treatment–Seeking Obese Sample. Prim Care Companion CNS Disord. 2014;16(5). doi:10.4088/PCC.14m01665.
  4. Fairburn CG, Cooper Z. The Eating Disorder Examination. In: Fairburn CG, Wilson GT, eds. Binge Eating: Nature, Assessment and Treatment. 12th ed. New York: Guilford Press; 1993:317–360.
  5. First MB, Spitzer RL, Gibbon M, et al. Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute; 2002.
  6. Fairburn CG, Beglin SJ. Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord. 1994;16:363-370.
  7. Yanovski S. Binge eating disorder: current knowledge and future directions. Obes Res. 1993;1:306-324.
  8. Gormally J, Black S, Duston S, et al. The assessment of binge eating severity among obese persons. Addict Behav. 1982;7:47-55.
  9. Garner DM, Olmstead MP, Polivy J. Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J Eat Disord. 1983;2:15-34.
  10. Stunkard AJ, Messik S. The three-factor eating questionnaire to measure dietary restraint disinhibition and hunger. J Psychosom Res. 1985;13:137
  11. White MA, Whisenhunt BL, Williamson DA, et al. Development and validation of the Food-Craving Inventory. Obes Res. 2002;10:107-114.
  12. Williams PM, Goodie J, Motsinger C. Treating eating disorders in primary care. Am Fam Physician. 2008;77:187-195.
  13. Brownley KA, Peat CM, La Via M, et al. Pharmacological approaches to the management of binge eating disorder. Drugs. 2015;75:9-32.

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