Binge Eating Disorder: Recent Changes in Diagnosis and Treatment

My Bariatric Life Health Guide
  • Based on recent DSM-5 changes in the diagnostic criteria for binge eating disorder (BED), it is likely that the number of patients diagnosed with BED will substantially increase. On a recent podcast, Dr. Tracy S. Cummings explored the prevalence of binge eating disorder, along with its link to obesity, and discussed screening and treatment options based on recent research and clinical trials.

     

    Dr. Tracy S. Cummings

    Dr. Tracy S. Cummings, Psychiatry, Lindner Center Of Hope, Mason OH

      

    What is Binge-Eating Disorder (BED)?

    An essential feature of BED is recurrent episodes of binge eating, at least once per week for 3 months, without recurrent inappropriate compensatory behavior typical of bulimia nervosa such as purging food or over exercising.

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    Bulimia Nervosa vs. Binge Eating Disorder, DSM-5 Criteria

    BN

    • Binge eating
    • Compensatory behaviors
    • Over-concern regarding shape, weight
    • Episodes 1x week for 3 months

     

    BED

    • Binge eating
    • Indicators of loss of control regarding binge eating
    • Marked distress
    • Episodes 1x week for 3 months

     

    A binge is defined as eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. As well, there is a sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).

     

    With this there is a strong sense of distress after the binge eating episodes. Some typical behaviors include:

    • Eating abnormally fast
    • Eating until uncomfortably full
    • Binging when not hungry
    • Eating alone due to embarrassment
    • Feeling depressed, disgusted or guilty after binging

     

    There also may be patterns of abnormal eating or unhealthy association with food that include:

    • Binge eating
    • Grazing: compulsive mild overeating
    • Objective overeating: overeating without loss of control
    • Subjective overeating: mild-to-moderate overeating with a sense of loss of control
    • Night eating: mild-to-moderate overeating only at 7pm (different from nocturnal binge eating)
    • Emotional eating: overeating in response to uncomfortable affect

     

    Association Between Binge Eating Disorder and Obesity

    Most patients whom have BED are overweight or obese, and nearly a third of people in weight-loss programs have BED. In these programs, participants with BED have higher average BMI than participants without BED. Half the participants with BMI of >40 have BED. In addition, 25-50 percent of patients seeking bariatric surgery have BED. 

     

    Additionally, metabolic syndrome, the cluster of abdominal obesity, elevated triglycerides, hypertension and type 2 diabetes, is present in more than 40 percent of obese patients with BED. And people with BED were twice as likely to develop syndrome components than the BMI-matched control group without BED. 

     

    Binge Eating Disorder vs. Obesity

    Binge eating differs from over-eating. There is a greater concern regarding shape and weight with BED and a greater psychiatric comorbidity. More than half the patients with BED have three or more additional psychiatric illnesses. As such, there are different treatment approaches to BED than to obesity alone. 

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    Treatment for BED

    Treatment goals for binge eating disorder include fewer binge eating episodes and obsessive compulsive symptoms. Your physicians should also look to reduce the comorbid psychiatric illnesses such as anxiety and depression. Additionally, prevention of further weight gain, achieving weight loss and metabolic health are treatment goals. 

     

    Treatments include cognitive behavioral therapy, interpersonal therapy, and dialectical behavioral therapy, and consideration of bariatric surgery. Medications choices include antidepressants and SSRIs to reduce BED, anti-obesity medications and ADHD drugs to reduce appetite, and anti-addiction drugs to reduce cravings.

     

    The full podcast can be listened to on ReachMD. 

     

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Published On: January 16, 2015