Binge-Eating Disorder

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Binge-Eating Disorder

Definition

Binge eating disorder (BED) is characterized by a loss of control over eating behaviors. The binge eater consumes unnaturally large amounts of food in a short time period, but unlike a bulimic, does not regularly engage in any inappropriate weight-reducing behaviors (for example, excessive exercise, vomiting, taking laxatives ) following the binge episodes.

Description

BED typically strikes individuals sometime between adolescence and the early twenties. Because of the nature of the disorder, most BED patients are overweight or obese. Studies of weight loss programs have shown that an average of 30% of individuals enrolling in these programs report binge eating behavior.

Causes and symptoms

Binge eating episodes may act as a psychological release for excessive emotional stress. Other circumstances that may predispose an individual to BED include heredity and affective disorders, such as major depression. BED patients are also more likely to have a comorbid, or co-existing, diagnosis of impulsive behaviors (for example, compulsive buying), post-traumatic stress disorder (PTSD), panic disorder, or personality disorders.

Individuals who develop BED often come from families who put an unnatural emphasis on the importance of food, for example, as a source of comfort in times of emotional distress. As children, BED patients may have been taught to clean their plate regardless of their appetite, or that finishing a meal made them a "good" girl or boy. Cultural attitudes towards beauty and thinness may also be a factor in the BED equation.

During binge episodes, BED patients experience a definite sense of lost control over their eating. They eat quickly and to the point of discomfort even if they aren't hungry. They typically binge alone two or more times a week, and often feel depressed and guilty once the episode has concluded.

Diagnosis

Binge eating disorder is usually diagnosed and treated by a psychiatrist and/or a psychologist. In addition to an interview with the patient, personality and behavioral inventories, such as the Minnesota Multiphasic Personality Inventory (MMPI), may be administered as part of the assessment process. One of several clinical inventories, or scales, may also be used to assess depressive symptoms, including the Hamilton Depression Scale (HAM-D) or Beck Depression Inventory (BDI). These tests may be administered in an outpatient or hospital setting.

KEY TERMS

Bulimia— An eating disorder characterized by binge eating and inappropriate compensatory behavior, such as vomiting, misusing laxatives, or excessive exercise.

Cognitive behavioral therapy— A therapy that pays particular attention to a patient's behavior and thinking processes rather than underlying psychological causes of an activity.

Treatment

Many BED individuals binge after long intervals of excessive dietary restraint; therapy helps normalize this pattern. The initial goal of BED treatment is to teach the patient to gain control over his eating behavior by focusing on eating regular meals and avoiding snacking. Cognitive-behavioral therapy, group therapy, or interpersonal psychotherapy may be employed to uncover the emotional motives, distorted thinking, and behavioral patterns behind the binge eating.

Because the prevalence of depression in BED patients is high, psychopharmacological treatment with antidepressants may also be prescribed. Once the binge eating behavior is curbed and depressive symptoms are controlled, the physical symptoms of BED can be addressed. The overweight BED patient may be placed on a moderate exercise program and a nutritionist may be consulted to educate the patient on healthy food choices and strategies for weight loss.

Prognosis

The poor dietary habits and obesity that are symptomatic of BED can lead to serious health problems, such as high blood pressure, heart attacks, and diabetes, if left unchecked. BED is a chronic condition that requires ongoing medical and psychological management. To bring long-term relief to the BED patient, it is critical to address the underlying psychological causes behind binge eating behaviors. It appears that up to 50% of BED patients will stop bingeing with cognitive behavioral therapy (CBT).