Binge Eating Disorder: Symptoms and Treatment

Binge Eating disorder or BED entails frequent and persistent episodes of irrepressible binge eating when regular compensatory behaviors are not present, as per the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; Telch and Agras, 2001). In layman terms, this eating disorder is exemplified by the consumption of an unusually large amount of food in a short period of time, typically two hours. Anderson et al. (2020) also describe it as a disorder that is characterized by objective binge episodes (OBE) that are linked to severe psychiatric and medical comorbidities. For instance, according to research, binge eating disorder has both a persistent and chronic course, and it typically linked to crucial health problems like obesity as well as psychiatric comorbidity. The current prevalence of the disorder shows that it is the most common eating disorder, particularly among adults. Minnick et al. (2017) estimate that the lifetime prevalence of an eating disorder, like binge eating disorder it typically 10% among men and women in the US, and in conjunction with bulimia nervosa, binge eating disorder is the most prevalent eating disorder. 

However, it has been depicted that the condition is more prominent in males in contrast to other eating disorders. It has also been shown that the bingeing episodes typically occur on a regular basis at least one episode each week, transpiring over three months. In addition, the primary difference between bulimia nervosa and binge eating disorder is that in bulimia nervosa, the binge eating episodes are accompanied by subsequent compensatory actions like vomiting, the utilization of diuretics or laxatives, excessive exercising, and fasting. Since binge eating is central to both binge eating disorder and bulimia nervosa, the treatment outcome research for binge eating disorder has paralleled that of bulimia nervosa. In particular, CBT or cognitive-behavioral treatment, pharmacotherapy, and interpersonal psychotherapy (IPT). Commonly, the tested treatments have depicted great promise, but they are ineffective for as many as half of the patients that are looking for treatment. 

Diagnostic Criteria and Key Pathological Elements 

As per the DSM-5, the diagnostic criteria for binge eating disorder include: 

Continuous and recurrent binge eating episodes whereby a binge eating episode is characterized by the following: 

A lack of control over eating amid the episodes (for instance, one feeling that they are overwhelmed by the feeling of eating and that they have no control over how or what they eat) 

Consuming in a discrete amount of time (for instance, in a two-hour period), a food amount which is more significant than most would consume in a similar time under the same situations. 

The episodes of binge eating are linked with three or more of the following: 

Eating until one feels uncomfortably full 

Eating more rapidly compared to the normal. 

Eating huge amounts of food when not feeling hungry. 

Eating alone typically because one feels ashamed of the amount of foods they consume. 

Feeling hopeless and disgusted with oneself, feeling guilty, or feeling depressed. 

There is the presence of distress in regards to the binge eating episodes. 

The binge-eating episodes occur at least once a week for a period of three months. 

The binge eating is not linked with the recurrent utilization of unsuitable compensatory actions and does not transpire exclusively amid the course of bulimia nervosa, anorexia nervosa, or restrictive/avoidant food consumption disorder. 

Diagnostic Tests and Exams for Binge Eating Disorder 

Over the last ten years, the number of researches in regards to binge eating disorder has significantly increased, and a plethora of self-report inventories have thus been developed in order to attain a diagnosis. These include the Binge Eating Scale, the Three-Factor Eating Questionnaire, as well as the Body Shape Questionnaire. Similarly, there are interview methods like Structured Clinical Interview and Eating Disorders Examination, which have all been developed to test binge eating disorder in adults (Bulik, 2007). However, there are continuous attempts at the refinement of the definition of binge eating episodes and to develop reliable and valid diagnostic criteria for binge eating disorder. Clinicians and researchers are usually unsuccessful in the assessment of what constitutes an “ unusually large amount of food, ” as this is usually subjective. Such inconsistencies make it challenging to determine the actual number of binge episodes that are experienced by a patient or participant in research. In the same manner, clinicians and researchers are undependable in the determination of whether the loss of control was present amid the binge eating episode. 

Even though initially founded mainly as an adulthood disorder, there are growing recognitions that binge eating disorders are also present in children and adolescents. Such progressions have called for the development of age-relevant and age-appropriate measures of assessment. The measures of assessment for children include the Eating Disorders Examination that was adapted for children as well as the adolescent version alluded to as the Questionnaire of Eating and Weight Patterns. Psychologists have speculated that flexible, broader criteria can be utilized to measure binge eating disorder in children. For instance, Marcus and Kalarchian (2003) recently proposed a holistic criteria for the measurement of binge eating disorder in children on the basis of synthesis and review of research findings. In addition, based on these criteria, Shapiro et al. (2007) conceptualized an ephemeral structured scale that is administered by an interviewer in order to quantity binge eating disorders in children that are aged between five and thirteen. The results indicate that there exists a robust connection between the Children Binge Eating Disorder Scale and Structured Clinical Interview for the Diagnosis of DSM disorders. Nevertheless, the former may be more developmentally suitable for children and is capable of identifying subsyndromal binge eating disorder. If utilized by health providers and physicians, the brief measure may aid in the identification of the early onset of binge eating disorders and circumventing the consequences that are linked to it. 

Factors Contributing to Binge Eating Disorder (Risk Factors) 

It is crucial to be conversant with the factors which contribute to the progression and maintenance of BED, such as personality disorders (PDs) and other leading psychopathology. College students that reported disordered eating behaviors also showcased higher tiers of personality disorder characteristics as well as psychological symptoms like anger, depression, and obsessive-compulsive actions in contrast to those who did not report (Minnick et al., 2017). In the same study, it was also found that as many as 81.9% of the participants with eating disorders had at least one primary psychiatric diagnosis, like anxiety, depression, and substance utilization disorders, and 69% of the participants had at least one diagnosis of a personality disorder. Similarly, a treatment investigation showed that early improvements in eating disorder symptomatology were linked to significant progress in cognitions of personality disorders as well as anxiety and depression. Therefore, this suggests a crucial link between eating disorders and both psychopathology and personality disorders (Minnick et al., 2017). 

The dysregulation, which usually goes with a personality disorder, is corresponding with that typically perceived in eating disorders, especially binge eating disorders and bulimia nervosa. For instance, Borderline personality disorder is usually linked with interpersonal dysfunction, affective liability, as well as behavioral disinhibition. In this manner, the presence of particular disordered patterns of personality may amplify the symptomatology perceived in BED and BD and complicates long-term outcomes and clinical intervention. For instance, a particular study depicted that among patients with BED, those that had psychiatric comorbidity, including substance utilization disorder, anxiety, and mood, had more prominent and serious symptoms of ED, higher negative emotions, as well as lower self-esteem in comparison to those with no psychiatric disorders. Similarly, in an intensive inpatient ED program, patients that did not make improvements that were not clinically significant were highly likely to possess comorbid borderline personality disorder than those that had better outcomes in their treatments. Therefore, on a holistic basis, these findings validate an essential synergistic affiliation between PDs, EDs, and other psychopathologies, which considerably affect treatments and their outcomes. 

Research has also depicted that not only are eating disorders generally related to psychopathology and personality disorders but also that there are considerable variances in comorbidity across the diagnoses of eating disorders. In particular, McGregor and Lamborn depicted that bulimia nervosa and binge eating disorder differed on different traits of personalities (2014). Patients of bulimia nervosa also depicted higher dominance of schizophrenia and depression. However, further research is necessary to ascertain the differences between binge eating disorder and bulimia nervosa. In a systematic investigation that embarked on binge eating disorder, those that had the disorder were highly likely to have comorbid personality disorders in contrast to those without binge eating disorders (Gerlack, 2016), thus depicting that binge eating disorder has a direct correlation with personality disorders. This comorbidity is perceived with more frequencies in the existence of psychological suffering, and among patients with binge eating disorder that have symptoms of depression, 46% possessed a comorbid personality disorder, while 10% of patients with binge eating disorder that had no depressive symptoms had this similar tier of comorbidity (Stice et al., 2001). 

There is also a plethora of research linking binge eating disorder and other disorders to culture. The validity and reliability of personality diagnoses have been garnered significant discourses transpiring over a long period of time, and there are myriads of research that examine personality disorder traits in populations that are ethnically diverse (Krueger et al., 2012), and it was also found that eating disorder may be affected by cultural factors thus emphasizing that cultural factors are crucial to consider. 

Genetic factors also play a robust role in the development and progression of binge eating disorder. Binge eating disorder risks tend to aggregate in families independent of the obesity risks, although the presence of binge eating disorder in a first-degree family relative increases obesity risk. According to Saules et al. (2016), heritability approximations for binge eating disorder range from 45% to 57%, which seems to be greater than the heritability of subthreshold binge eating. Similarly, symptom-level investigation support moderate genetic contributions for each binge eating disorder symptom, thus supporting the dependability of the criteria for diagnosis. Also, the shared environment has a role in the familial transmission of binge eating disorder, and the influence of unique elements of the environment in the development and maintenance of binge eating disorder is substantial. 

In regards to the neurobiological foundations of binge eating disorders, it seems that it is linked with hypersensitivity to reward, a phenomenon which is robustly linked with the dopaminergic and striatum mechanisms. In concurrence with this hypothesis, scientists reported that binge eating disorder was differently linked to genotypes, which reflect a higher density of D2 receptors and more D2 binding potential in contrast to obese controls. In addition, an increase in striatal DA and distinct patterns of activation in the right ventral striatum have been depicted in patients with binge eating disorder in comparison to obese non-binge eating disorder controls in reaction to stimuli that are food-related. Other research findings have indicated the orbitofrontal cortex in binge eating disorder, which is the region responsible for the processing of rewards, especially as it is associated with the hedonic value of food stimuli. Increased grey matter volumes have been depicted in individuals with binge eating disorder in contrast to normal controls and more significant activation of medial OFC while viewing food pictures in people with binge eating disorder. 

Difficulties in the regulation of affect have also been implied in the progression of binge eating disorder. Two of the most prominent theories utilized in the elucidation of this phenomenon are the escape and regulation theory. According to the affect regulation theory, binge eating is a response that is conditioned to negative affect that is conforming negatively and is reinforced by a decrease in negative affect, which could occur after or during binge eating. Escape theory, on the other hand, contends that aversive self-awareness leads to negative affect, thus consequently triggering binge eating. Binge eating is ergo, reinforced negatively by a decrease in negative affect amid a binge through an escape from self-awareness, which is attained via cognitive contraction to the direct stimulus environ. In comparison to the affect regulation model, the escape model forecasts that negative affect increases after binge eating after the self-awareness is restored. 

Risks Associated with Binge Eating Disorders 

Among the most cited risk factors linked with binge eating disorder is obesity (Tanofsky-Kraff et al., 2020). With the recognition of the heterogeneous nature of obesity, researchers sought after the illumination of potentially changeable risk factors which facilitate obesity. Obesity is influenced by a myriad of factors like socio-cultural determinants as well as metabolic and genetic influences that collectively affect energy expenditure and intake. Combining these factors, binge eating disorder and other eating disorders are continuously linked to obesity in epidemiological research (Tanofsky-Kraff et al., 2020). Obesity is a risk factor because of the loss of control of what one eats. Therefore, the specific impacts of binge eating disorder on health risks are difficult to isolate from the effects of obesity on one’s health, because the two conditions typically co-occur and have been co-founded in numerous investigations (Saules et al., 2016). 

Even though individuals with binge eating disorder are typically obese, the proponents of the classification of binge eating disorder as a disparate DSM diagnosis contend that people with binge eating disorder differ from their counterparts regarding eating patterns, psychopathology of eating disorders, and linked comorbidities and features. People with binge eating disorder usually consume more calories in experimentations in contrast to the controls. However, studies utilizing ecological momentary assessment found no major disparities between non-binge eating disorder obese participants and binge eating disorder obese participants, especially in regards to the frequency of binge eating and caloric consumption amid binge eating episodes. Nevertheless, participants with binge eating disorder were more likely to perceive a stronger desire to binge, stress, negative emotions, dietary restraints, and being lonely immediately after the bingeing episodes. There are also several health risks associated with binge eating disorders as a result of obesity including cardiovascular diseases, type 2 diabetes, sleep apnea, and insomnia, hypertension, gallbladder disease, joint/muscle pain, anxiety and depression, headaches, shortness of breath, low life quality, and gastrointestinal difficulties. A 5-year study follow-up of 134 patients with binge eating disorder and 134 individuals with no history of binge eating disorders provides further evidence that binge eating disorder consists of elements of metabolic syndrome apart from the risks linked with BMI (Saules et al., 2016). 

Binge eating disorder is also associated with poor social adjustment, significant impairment in functioning, and considerable psychiatric comorbidity, including suicidality and overall distress. In an investigation of comorbidity with selected disorders, including anxiety, mood, impulse-control, and substance abuse, almost 80% of the participants with binge eating disorder had a lifetime history of at least comorbidity, while 20% had a comorbid disorder, 50% had three or more, while 10% had two (Saules et al., 2016). Furthermore, the existence of present psychiatric comorbidity is linked with a greater eating disorder linked psychopathology and other disorders associated with it. The comorbidities that are most common also include post-traumatic stress disorder, phobia, major depressive disorder, social phobia, PTSD, alcohol dependence or abuse, attention deficit, illegal drug dependence, as well as oppositional-defiant disorder. A recent study report claims that this level of comorbidity is present in settings of primary care, noting that post-traumatic stress disorder is common and linked with a host of numerous challenges including anxiety, eating pain, diabetes, depression, drug use disorders, low life quality, as well as functional and psychological impairments. 

Treatment and Management of Binge Eating Disorder 

Notwithstanding the adverse sequelae of binge eating disorder, studies state that it is typically untreated (Saules et al., 2016). However, there are numerous promising treatment options for binge eating disorder. They are each discussed below: 

Cognitive Behavioral Therapy 

This therapy is generally considered as the most empirically supported and well-established treatment for binge eating disorder. The cognitive-behavioral therapy for eating disorders contends that central pathology in eating disorders is a system that is dysfunctional where self-worth is contingent upon eating habits, weight, shape, and the capacity of the individual to control them. The treatment is focused on the normalization of the patterns of eating, cognitive reformation for shape/weight concerns, as well as other stimuli for the binge eating episodes, and prevention of relapses. 

Interpersonal Psychotherapy 

This treatment addresses interpersonal challenges in four major areas, including interpersonal conflict, role transitions, grief, as well as interpersonal deficits. Amid the adaptation of interpersonal psychotherapy to binge eating disorder, it was established that the course of binge eating disorder is usually more chronic than the depression course. Therefore, the focus of interpersonal therapy on binge eating disorder was moved from solving the disorder’s interpersonal precipitants to the interpersonal factors which maintain the disorder. 

Dialectic Behavior Therapy 

Originally intended for the treatment of borderline personality disorder, this treatment option typically targets the regulation of emotions. According to the core functioning of this treatment, emotional dysregulation is the primary psychopathology in this disorder, and thus binge eating is perceived as attempts to change, control, or change emotions of pain. 

Meditation and Mindfulness-Based Therapies 

Treatments utilizing this therapy reasons that negative affect, emotional eating, and eating in the absence of hunger may encompass one way to binge eating and therefore, mindfulness-based therapies work via impacts on the regulation of emotions, decrease of negative affect via acceptance strategies, as well as awareness of bodily cues. The treatment is thus targeted at the cultivation of mindful eating, mindfulness, self-acceptance, and emotional balance. Similarly, it puts an emphasis on the development of self-awareness of satiety cues and internal hunger. 

Self-Help Interventions 

These types of interventions are usually categorized as self-help or guided and are undertaken with a self-help manual. This treatment is usually effective, cost-effective, flexible, and is less intensive compared to other treatment methods. Researchers have suggested that individuals with eating disorders ought to start with the least-intensive appropriate treatment and then move on to more intensive programs if there are no improvements. Most clinical trials for eating disorders depict that if there are no improvements by the fourth week, the individual is less likely to benefit from that method of treatment. 

Pharmacologic Treatment 

Presently, lisdexamfetamine dimesylate is an FDA-approved medication for the treatment of binge eating disorder. This drug was previously approved for the treatment of attention deficit hyperactivity disorder in adults and children. It is a central nervous system stimulant and has been depicted to decrease binge days as well as episodes considerably. 

References  

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