Binge eating disorder is characterized by recurrent episodes of consuming large amounts of food with a feeling of loss of control. It is not followed by inappropriate compensatory behavior, such as self-induced vomiting or laxative abuse. Diagnosis is clinical. Treatment is with cognitive behavioral therapy or sometimes interpersonal psychotherapy or drugs (selective serotonin reuptake inhibitors [SSRIs] or lisdexamfetamine).
(See also Introduction to Eating Disorders.)
Binge eating disorder affects about 3.5% of women and 2% of men in the general population during their lifetime. Unlike bulimia nervosa, binge eating disorder occurs most commonly among people with overweight or obesity and contributes to excessive caloric intake; it may be present in ≥ 30% of patients in some weight-reduction programs. Compared with people with anorexia nervosa or bulimia nervosa, those with binge eating disorder are older and more likely to be male.
Symptoms and Signs of Binge Eating Disorder
During a binge episode, people eat a much larger amount of food than most people would eat in a similar time under similar circumstances. During and after a binge, people feel as if they have lost control. Binge eating is not followed by purging (by inducing vomiting, misusing laxatives, diuretics, or enemas), excessive exercising, or fasting. Binge eating occurs in episodes; it does not involve constant overeating ("grazing").
People with binge eating disorder are distressed by it. Mild to moderate depression and preoccupation with body shape, weight, or both are more common in people with obesity who have binge eating disorder than in people of similar weight who do not binge eat.
Diagnosis of Binge Eating Disorder
Clinical criteria
Clinical criteria for diagnosis of binge eating disorder (1) require that
Binge eating occurs, on average, at least once a week for 3 months
Patients have a sense of lack of control over eating
In addition, ≥ 3 of the following must be present:
Eating much more rapidly than normal
Eating until feeling uncomfortably full
Eating large amounts of food when not feeling physically hungry
Eating alone because of embarrassment
Feeling disgusted, depressed, or guilty after overeating
Binge eating disorder is differentiated from bulimia nervosa (which also involves binge eating) by the absence of compensatory behaviors (eg, self-induced vomiting, use of laxatives or diuretics, excessive exercise, fasting).
Diagnosis reference
1. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision, DSM-5-TRTM, Feeding and eating disorders.
Treatment of Binge Eating Disorder
Cognitive behavioral therapy
Sometimes interpersonal psychotherapy
Consideration of drug therapy, usually selective serotonin reuptake inhibitors (SSRIs) or lisdexamfetamine
Cognitive behavioral therapy is the most studied and best supported treatment for binge eating disorder, but interpersonal psychotherapy appears equally effective. Both result in remission rates of ≥ 60%, and improvement is usually well-maintained over the long term. These treatments do not produce significant weight loss in patients with obesity.
Conventional behavioral weight-loss treatment has short-term effectiveness in reducing binge eating, but patients tend to relapse. Antidepressant drugs (eg, SSRIs) also have short-term effectiveness in eliminating binge eating, but long-term effectiveness is unknown. Lisdexamfetamine is approved for the treatment of moderate to severe binge eating disorder. It can reduce the number of binge days and appears to cause slight weight loss, but its long-term effectiveness is unknown. Appetite-suppressing drugs (eg, topiramate) or weight-loss drugs (eg, orlistat) may be helpful.
Key Points
People with binge eating disorder have episodes of consuming large quantities of food, do not compensate by vomiting or purging, and tend to have overweight or obesity.
Diagnose binge eating disorder based on clinical criteria (including binge eating, on average, at least once/week for 3 months, with a sense of lack of control over eating).
Treat with cognitive behavioral therapy or interpersonal psychotherapy and sometimes drugs (eg, SSRIs, lisdexamfetamine).
