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, doesn't regularly engage in any inappropriate weight-reducing behaviors (like excessive exercise, vomiting , taking laxatives) after the binge episodes.

Description

About three percent of women and one-tenth as many men have duffered from either bulimia or binge eating disorder at some time in their lives. BED typically strikes individuals between their adolescent years and their early 20s. 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. Binge eating in milder forms is even more common, as are attempts to compensate for the binges.

Causes & 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 mood disorders, such as major depression . BED patients are also more likely to have an additional diagnosis of impulsive behaviors (for example, compulsive shopping), post-traumatic stress disorder (PTSD), panic disorder , or personality disorders. More than half also have a history of major depression. In 2002, the American Psychiatric Association was considering including BED as a psychiatric diagnosis.

Individuals who develop BED often come from families who put an unnatural emphasis on the importance of food. For example, these families may use food as a source of comfort in times of emotional distress. As children, BED patients may have been taught to clean their plates regardless of their appetite, or to be a good girl or boy and finish all of the meal. Cultural attitudes towards beauty and thinness may also be a factor in BED.

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 when the episode is over.

Diagnosis

BED 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.

Treatment

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

Initial treatment may focus on curbing the depression that is a characteristic feature of BED. Recommended herbal remedies to ease the symptoms of depression may include damiana (Turnera diffusa ), ginseng (Panax ginseng ), kola (Cola nitida ), lady's slipper (Cypripedium calceolus ), lavender (Lavandula angustifolia ), lime blossom (Tilia x vulgaris ), oats (Avena sativa ), rosemary (Rosmarinus officinalis ), skullcap (Scutellaria laterifolia ), St. John's wort (Hypericum perforatum ), valerian (Valeriana officinalis ), and vervain (Verbena officinalis ).

Binge-eating episodes that appear to be triggered by stress may be curbed by educating the patient in relaxation exercises and techniques, including aromatherapy , breathing exercises, biofeedback, music therapy, yoga , and massage. Herbs known as adaptogens may also be prescribed by an herbalist or holistic healthcare professional. These herbs are thought to promote adaptability to stress, and include Siberian ginseng (Eleutherococcus senticosus ), ginseng (Panax ginseng ), wild yam (Dioscorea villosa ), borage (Borago officinalis ), licorice (Glycyrrhiza glabra ), chamomile (Chamaemelum nobile ), and nettles (Urtica dioica ). Tonics of skullcap (Scutellaria lateriafolia ), and oats (Avena sativa ), may also be recommended to ease anxiety .

Allopathic treatment

Treatment with antidepressants may be prescribed for BED patients. Selective serotonin reuptake inhibitors (such as Prozac) are usually preferred because they offer fewer side effects. However, clinical studies don't show much effectiveness for use of antidepressants in treating BED. Psychotherapy shows better results. Once the binge eating behavior is curbed and depressive symptoms are controlled, the physical symptoms of the disorder can be addressed.

Expected results

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.

Resources

BOOKS

Abraham, Suzanne and Derek Llewellyn-Jones. Eating Disorders: The Facts. 4th ed. Oxford: Oxford University Press, 1997.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Press, Inc., 1994.

Siegel, Michele, Judith Brisman, and Margot Weinshel. Surviving an Eating Disorder: Strategies for Family and Friends, 2nd ed. New York: Harper Perennial, 1997.

PERIODICALS

Brewerton, Timothy D. "Binge Eating Disorder: Recognition, Diagnosis, and Treatment." Medscape Mental Health 2, no. 5 (1997). http://www.medscape.com.

"Treatment of Bulimia and Binge Eating." Harvard Mental Health Letter (July 2002).

Tufts University. "Binge Eating Disorder Comes Out of the Closet: Experts Say Leading Obesity Factor Has Long Been Overlooked." Tufts University Diet & Nutrition Letter 14, no. 11 (January 1997): 4-5.

ORGANIZATIONS

American Psychiatric Association (APA). Office of Public Affairs. 1400 K Street NW, Washington, DC 20005. (202) 682-6119. http://www.psych.org/.

American Psychological Association (APA). Office of Public Affairs. 750 First St. NE, Washington, DC 20002-4242. (202) 336-5700. http://www.apa.org/.

Eating Disorders Awareness and Prevention. 603 Stewart St., Suite 803, Seattle, WA 98101. (800) 931-2237. http://www.edap.org

National Eating Disorders Organization (NEDO). 6655 South Yale Ave., Tulsa, OK 74136. (918) 481-4044.

Overeaters Anonymous World Service Office. 6075 Zenith Ct. NE, Rio Rancho, NM 87124. (505) 891-2664. http://www.overeatersanonymous.org/.

Paula Ford-Martin

Teresa G. Odle

Binge eating disorder

Definition

Binge eating disorder (BED) is characterized by 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 such as excessive exercise , induced vomiting , or 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 percent of individuals enrolling in these programs report binge eating behavior.

Demographics

Binge eating affects an equal numbers of females and males. Although there are no good statistics on how many children suffer from the condition, an estimated 1 to 2 million Americans of all ages are binge eaters. Many of them report that their condition started in childhood.

Causes and symptoms

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

Individuals who develop BED often come from families who put an extreme emphasis on the importance of food as a source of comfort in times of emotional distress. Children with BED may have been taught to clean their plates regardless of their satiety or that their finishing a meal makes them a "good" girl or boy. Cultural attitudes towards beauty and thinness may also be a factor in whether a person binges.

During binge episodes, BED patients experience a definite loss of control over their eating. They eat quickly and to the point of discomfort even if they are not hungry. They typically binge alone two or more times a week and often feel depressed and guilty when the episode concludes.

Diagnosis

Binge eating disorder is usually diagnosed and treated by a psychiatrist and/or a psychologist. In addition to an interview with the child, 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.

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 the eating behavior by focusing on eating regular meals and avoiding snacking. Cognitive-behavioral therapy (learning new behavior), 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, 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

If left unchecked, 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 type 2 diabetes. BED is a chronic condition that requires ongoing medical and psychological management. Some of these conditions such as diabetes can occur in young people. To bring long-term relief to the BED patient, it is critical to address the underlying psychological causes for binge eating behaviors. It appears that up to 50 percent of BED patients stop bingeing with cognitive behavioral therapy.

Parental concerns

Binge eating can lead to excessive weight, a risk for serious current and future diseases including heart disease, type 2 diabetes, and cancer . Overweight children also suffer from psychological distress, particularly when teased or shunned by peers. Parents should be aware that antidepressant drugs used to treat BED as of 2004 contain a warning that recommends close observation of pediatric patients treated with the drugs. In some cases, worsening depression or emergence of suicidal tendencies may occur.

KEY TERMS

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

Cognitive-behavioral therapy —A type of psychotherapy in which people learn to recognize and change negative and self-defeating patterns of thinking and behavior.

See also Bulimia nervosa.

Resources

BOOKS

Gay, Kathlyn. Eating Disorders: Anorexia, Bulimia, and Binge Eating. Berkeley, NJ: Enslow Publishers, 2003.

Matthews, Dawn D. Eating Disorders Sourcebook: Basic Consumer Health Information about Eating Disorders . . . Detroit, MI: Omnigraphics, 2001.

Parker, James N., et al. The 2002 Official Parent's Sourcebook on Binge Eating Disorders. Boulder, CO: netLibrary, 2002.

ORGANIZATIONS

American Psychiatric Association. 1400 K Street NW, Washington DC 20005. Web site: <www.psych.org>.

American Psychological Association (APA). 750 First St. NE, Washington, DC 20002–4242. Web site: <www.apa.org>.

Eating Disorders Awareness and Prevention. 603 Stewart St., Suite 803, Seattle, WA 98101. Web site: <www.edap.org>.

National Eating Disorders Association (NEDA). 603 Stewart St., Suite 803, Seattle, WA 98101. Web site: <www.nationaleatingdisorders.org>.

Overeaters Anonymous World Service Office. 6075 Zenith Ct. NE, Rio Rancho, NM 87124. Web site: <www.overeatersanonymous.org>.

Christine Kuehn Kelly

Binge eating

Description

Binge eating is a form of overeating in which a person ingests a large amount of food during a discrete period of time (within one or two hours, for example) and experiences feelings of being out of control and unable to stop eating during the episode. In practice, the duration of a binge may vary greatly from one event to the next, making it difficult to define the number of binges occurring in a given day. Binge eating often occurs in the absence of hunger and is characterized by eating very rapidly; eating alone (due to embarrassment over the amount being eaten); and having strong negative feelings, such as guilt, shame and depression, following the binge. Typically, a binge episode ends only when all the desirable binge foods have been consumed or when the person feels too full to continue eating.

While binge eating is a symptom of bulimia nervosa , it differs from this disorder in that behaviors intended to get rid of the food (fasting, excessive exercise, or using laxatives or inducing vomiting to "purge" the food from the system) are present among those with bulimia, but are generally absent among binge eaters. Binge eating may also occur in anorexia nervosa .

The clinician's diagnostic handbook, the Diagnostic and Statistical Manual of Mental Disorders (fourth edition, text revised, published in 2000) subsumes binge eating under the diagnosis of eating disorders not otherwise specified. Binge eating disorder is, however, under consideration as a separate diagnostic category, pending further study.

Symptoms and treatments

Binge eating episodes may occur in response to strong negative emotions, such as depression or anxiety, or to less defined feelings of distress or tension. The act of bingeing seems to alleviate these uncomfortable feelings temporarily and binge eaters typically describe themselves as "numb" or "spaced out" while engaged in these behaviors. Some people report that binges are related to the ingestion of certain "trigger foods," usually carbohydrates, but regardless of the stimulus, the feeling of eating without being able to control one's intake is a frightening experience for most people. The aftermath of a binge often includes an overwhelming sense of self-disgust, depression and anxiety.

While people who binge eat are clearly at high risk for becoming overweight, there are important differences between simple obesity and binge eating. People who binge eat are far more likely to report significant mood problems, especially depression, and to report greater dissatisfaction with their weight and shape than are comparably obese persons. They are also more likely to describe themselves as experiencing personal problems and work difficulties and to be hypersensitive to the thoughts and opinions of others. Like people with bulimia nervosa, they also have an increased likelihood of being diagnosed with major depression, substance-related disorders, and personality disorders , yet the overall rates of recovery for binge eating disorders are actually more favorable than those obtained in bulimia.

Binge eating is not common among the general public, but it is prevalent among persons attending weight loss clinics, where as many as half of the participants may fit this description. Both males and females develop binge-eating problems, but the rate of occurrence is 1.5 times greater among women. Age of onset is usually adolescence through young adulthood and the course of the disorder is often marked by a long history of on-again, off-again dieting.

As is the case with other forms of eating disorders, identification of specific causes for binge eating has been difficult. Since many people report relief from painful or uncomfortable mental states while bingeing, the behavior offers short-term emotional relief, making it likely to be repeated. Some investigators have considered genetic influences and personality variables. Still others have suggested that the "culture of thinness" in western societies contributes to the tendency toward harsh self-evaluation characterizing binge-eaters who then turn to food for solace.

At present, the most effective treatment approach to reducing the incidence of binge eating appears to be cognitive-behavioral therapy (CBT). The goal of this therapy is the development of skills for effectively coping with emotional distress rather than seeking to numb or disguise troubling feelings. This therapy focuses on helping the affected individual to decrease the binge eating behavior by recognizing the connection between thoughts and behavior, and to change behavior by changing negative thinking patterns. Follow-up research has been very encouraging, documenting both a decrease in depressive symptoms and a corresponding likelihood of healthy weight loss as the individual achieves better control of eating behaviors.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association, 2000.

Bowers, Wayne A. "Eating Disorders." In Cognitive-Behavioral Group Therapy, edited by John R. White and Arthur S. Freeman. Washington, DC: American Psychological Association, 2000.

Striegel-Moore, Ruth H., and Linda Smolak, eds. Eating Disorders: Innovative Directions in Research and Practice. Washington DC: American Psychological Association, 2001.

Thompson, J. Kevin, and others. Exacting Beauty: Theory, Assessment, and Treatment. Washington, DC: American Psychological Association, 1999.

Tobin, David L. Coping Strategies Therapy for Bulimia Nervosa. Washington, DC: American Psychological Association, 2000.

Jane A. Fitzgerald, Ph.D.

Binge Eating

Binge eating disorder (BED), also known as compulsive overeating, has been designated as a psychiatric disorder requiring further study by the American Psychiatric Association. Like bulimics, individuals suffering from binge eating disorder indulge in regular episodes of gorging, but unlike bulimics, they do not purge afterward. Binges are accompanied by a similar sense of guilt, embarrassment, and loss of self-control seen among bulimics. Because of the tremendous number of calories consumed, many people with BED are overweight or obese , and as a result they are more prone to complications such as high blood pressure , diabetes , high cholesterol , and heart disease .

A clinical diagnosis of BED requires bingeing at least two times a week for a period of six months or longer.

see also Addiction, Food; Bulimia Nervosa; Eating Disorders; Eating Disturbances; Yo-Yo Dieting.

Karen Ansel

Bibliography

American Dietetic Association (1998). Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Eating Disorder Not Otherwise Specified (EDNOS). Chicago.

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Washington, DC.

Escott-Stump, Sylvia, and Mahan, L. Kathleen (1996). Krause's Food, Nutrition, and Diet Therapy, 9th edition. Philadelphia: W. B. Saunders.

Binge Eating Disorder

Eating for Comfort

What Is Binge Eating Disorder?

What Causes Binge Eating Disorder?

How Is Binge Eating Disorder Diagnosed and Treated?

Can Binge Eating Disorder Be Prevented?

Resources

Binge eating is out-of-control eating. A person with binge eating disorder exhibits a repetitive pattern of bingeing that often results in overweight or obesity*, “yo-yo dieting,” and guilty or embarrassed feelings.

* obesity

(o-BEE-si-tee) is an excess of body fat. People are considered obese if they weigh more than 30 percent above what is healthy for their height.

Keywords

for searching the Internet and other reference sources

Binge and purge

Food and nutrition

Compulsive overeating

Overweight

Eating for Comfort

Rebecca’s parents sometimes got into fights that literally scared her out of the house. She often ended up at her neighbor’s house, where she was treated to hot chocolate, cookies, and other goodies. Eating in the comfort of her neighbor’s home always soothed Rebecca and lessened the pain she felt when her parents fought. Before long, Rebecca didn’t bother going to her neighbor’s house; she’d find a private place at home and eat whatever sweets she could find. She tried not to do it too often because it made her gain weight, but sometimes she felt she just couldn’t stop. She was ashamed of what she did, but it took her mind off her problems.

What Is Binge Eating Disorder?

People who binge on a regular basis have binge eating disorder. Bingeing means eating abnormally large quantities of food (sometimes thousands of calories) in one sitting. Binge eating is sometimes referred to as compulsive overeating because the person feels little control to resist or stop overeating. People who binge often eat when they are not hungry. Women and girls are more likely to have binge eating disorder, but it can affect boys as well. The number of people with this disorder is estimated at 1 to 2 percent of men and women. As many as 30 percent of all women who seek medical treatment to lose weight have binge eating disorder.

Binge eating disorder is similar to another eating disorder called bulimia (bu-LEE-me-a). A person with bulimia binges and then purges. Purging means using vomiting, laxatives, and enemas to rid the body of food. A person with binge eating disorder binges but does not purge.

What Causes Binge Eating Disorder?

The causes of binge eating disorder are hard to pinpoint, but a number of factors are thought to contribute to the problem. People who have binge eating disorder are usually overweight and/or are constantly dieting. Preoccupied with food, they are caught in a cycle of dieting excessively, becoming too hungry, and then overeating. People who have trouble dealing with stress or painful emotions may use binge eating as comfort. Those who have a family history of obesity may be more likely to binge eat. The cultural preoccupation with thinness and dieting also plays an important role in binge eating and in other eating disorders. People who binge are often torn between their feelings of comfort with food, their wish to be thin, and the confusing messages about food and about thinness in the media.

How Is Binge Eating Disorder Diagnosed and Treated?

People with binge eating disorder often seek help from a health care professional because they want to lose weight or because of concern about health problems related to obesity. A careful evaluation that involves questions about family and personal history, physical health, eating and dieting habits, psychological concerns, and personality issues may bring binge eating disorder to light.

Like other eating disorders, overcoming binge eating may take a long time, lots of commitment, and hard work. Treatment usually involves a number of professionals, such as a physician, a nutritionist, and/or a therapist. Treatments include counseling, change in eating and dieting habits, support groups, nutritional counseling, individual or group psychotherapy, and in some cases, medication.

Can Binge Eating Disorder Be Prevented?

According to Anorexia Nervosa and Related Eating Disorders, Inc. (ANRED), prevention involves becoming more aware of what triggers a binge and making choices that help to avoid a binge. They provide the following guidelines that may help prevent binge eating disorder:

• eating regularly and avoiding getting too hungry
• not avoiding good tasting food
• eating small or moderate amounts of favorite foods
• having satisfying experiences that do not involve food
• keeping tabs on feelings so they will not lead to binge eating
• being wary of temptations, such as “all you can eat” buffets

See also

Bulimia

Eating Disorders

Emotions

Obesity

Resources

Organizations

Anorexia Nervosa and Related Eating Disorders, Inc. (ANRED), P.O. Box 5102, Eugene, OR 97405-0102. Telephone 541-334-1144 http://www.anred.com

Eating Disorders Awareness and Prevention, Inc. (EDAP), 603 Stewart Street, Suite 803, Seattle, WA 98101. Telephone (800) 931-2237 for toll-free information and referral hotline http://www.edap.org

Overeaters Anonymous, 6075 Zenith Ct., N.E., Rio Rancho, NM 87124. Telephone 505-891-2664 http://www.overeatersanonymous.org