Binge eating disorder

Dr. Fernando Fernández-Aranda

Binge eating disorder (BED) is characterized by regular binge eating episodes during which individuals ingest comparably large amounts of food and experience loss of control over their eating behaviour. The worldwide prevalence of BED for the years 2018–2020 is estimated to be 0.6–1.8% in adult women and 0.3–0.7% in adult men. BED is commonly associated with obesity and with somatic and mental health comorbidities. People with BED experience considerable burden and impairments in quality of life, and, at the same time, BED often goes undetected and untreated. The aetiology of BED is complex, including genetic and environmental factors as well as neuroendocrinological and neurobiological contributions. Neurobiological findings highlight impairments in reward processing, inhibitory control and emotion regulation in people with BED, and these neurobiological domains are targets for emerging treatment approaches. Psychotherapy is the first- line treatment for BED. Recognition and research on BED has increased since its inclusion into DSM-5; however, continuing efforts are needed to understand underlying mechanisms of BED and to improve prevention and treatment outcomes for this disorder. These efforts should also include screening, identification and implementation of evidence- based interventions in routine clinical practice settings such as primary care and mental health outpatient clinics. Binge eating disorder (BED) is an eating disorder that was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 2013 (ref.1) and the International Classification of Diseases (ICD) in 2019 (ref.2) (Fig. 1; Table 1; Box 1). The core psychopathology characterizing BED includes regular binge eating episodes during which individuals ingest comparably large amounts of food in a discrete time period (such as within any 2- h period), whilst experiencing loss of control over their eating behaviour1. To fulfil the diagnosis according to DSM-5 criteria1, these episodes have to occur at least once a week for at least 3 months and have to be associated with distress regarding binge eating (Table 1). Moreover, DSM-5-defined binge eating episodes are associated with at least three of the following five characteristics: eating much more rapidly than normal, eating until feeling uncomfortably full, eating despite not feeling physically hungry, eating alone because of embarrassment about the amount and negative feelings after overeating1. BED and the eating disorder bulimia nervosa (BN) are both characterized by regular binge eating episodes1; however, the regular use of one or more inappropriate compensatory behaviours to prevent weight gain (such as self- induced vomiting or fasting) is part of the diagnostic criteria for BN1, whereas individuals with BED do not regularly compensate using inappropriate methods. Moreover, diagnostic criteria for the eating disorders anorexia nervosa (AN)3,4 and BN also include disturbances associated with body image (such as over- evaluation of weight and shape), which is not required for a BED diagnosis1. Similar to other mental disorders, the pathophysiology of BED is complex and multifactorial, with biological, individual and social variables contributing to dysregulated eating and other related behaviours. Dysfunctions across the spectrum of impulsivity might lie at the core of BED, and include alterations related to reward processing, inhibitory control and emotion regulation. BED is an important health issue as it is highly prevalent in the general population5–7 and is often associated with obesity and extreme obesity7. Indeed, up to 30% of individuals with obesity seeking behavioural or surgical weight loss treatment have co- occurring BED8,9. This highlights the clinical importance of BED, especially given that average BMI continues to rise globally10 and the World Health Organization has identified the worldwide obesity ‘epidemic’ as one of the major global health problems11. However, although elevated BMI is associated with BED, weight loss as a treatment outcome for BED is controversial, with guidelines prioritizing behavioural outcomes such as reduction in or abstinence from binge eating as a primary treatment goal for BED12,13

Publication information

Title: Binge eating disorder

Authors: Katrin E. Giel, Cynthia M. Bulik, Fernando Fernandez- Aranda, Phillipa Hay, Anna Keski- Rahkonen, Kathrin Schag, Ulrike Schmidt, Stephan Zipfel

Journal: Nature Reviews Disease Primers

Year: 2022

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