Binge eating disorder

• Binge eating disorder is characterised by recurrent episodes of binge eating. A binge is defined as consuming an abnormally large amount of food in a relatively short period of time, which is associated with a sense of loss of control. Individuals often eat rapidly, in secret, and to the point of physical discomfort. After the binge, the individual often feels guilty, disgusted, or low in mood.
• In binge eating disorder, unlike bulimia nervosa, the individual does not engage in inappropriate compensatory behaviours in response to a binge with the aim of preventing weight gain.
• Risk factors for binge eating disorder include:

  • Female sex
  • Family history of weight concerns or eating problems
  • Co-morbid mental health disorder (e.g. depression, anxiety): episodes of binge eating may be triggered by negative emotions and aim to provide relief/distraction from them.
  • Co-morbid substance misuse
  • Co-morbid impulse control disorder (e.g. attention deficit hyperactivity disorder)
  • Childhood obesity
  • Dieting may play a role in the development as food restriction can result in overeating
  • Stressful life events
  • Mu-opioid receptor and dopamine receptor genes are thought to play a role
• ICD-11 diganosis:

  • Binge eating once a week or more over a period of 3 months
  • Binge eating defined as a discrete period of time e.g. 2 hours during which the person loses control
  • Binge eating episodes not accompanied by inappropriate compensatory behaviours
  • Symptoms not better accounted for by another medical condition or mental disease
  • Marked distress about the pattern of binge eating or significant impairment of functioning
• Management:

  • Step 1 - Evidence-based guided self-help programme: involves the individual working their way through a self-help book about binge eating disorder and having short sessions with a therapist.
  • Step 2 - Group eating-disorder-focused cognitive behavioural therapy (CBT-ED): individuals engaging in group CBT-ED are offered 16 sessions of 90 minutes over 16 weeks (4 months).
  • Step 3 - Individual eating-disorder-focused cognitive behavioural therapy (CBT-ED): a course of individual CBT-ED typically consists of 16 to 20 weekly sessions.
• CBT-ED:

  • Establishing regular healthy eating patterns: advise the person to not try to diet or restrict food during treatment, because this is likely to trigger binge eating.
  • Ongoing weekly monitoring: this includes binge eating behaviours, dietary intake, and weight.
  • Identifying binge eating cues (situations, thoughts, emotions)
  • Address body image issues.
  • Completion of CBT homework in between sessions.
• Those with a binge eating disorder are at risk of metabolic syndrome. Metabolic syndrome is a group of comorbid conditions that increase the risk for cardiovascular events. These conditions include:

  • Central obesity
  • Type 2 diabetes mellitus (high triglycerides, low HDL)
  • Hypertension
  • Hypercholesterolaemia
• The course of binge eating disorder typically consists of cycles of symptom remission and symptom recurrence/relapse. Approximately 70-80% of individuals with binge eating disorder will recover over time.