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Binge Eating Disorder

by Evelyn Attia, MD, B. Timothy Walsh, MD

Binge eating disorder is characterized by recurrent episodes of consuming large amounts of food with a feeling of loss of control. It is not followed by inappropriate compensatory behavior, such as self-induced vomiting or laxative abuse. Diagnosis is clinical. Treatment is with cognitive-behavioral therapy or sometimes interpersonal psychotherapy.

Binge eating disorder affects about 3.5% of women and 2% of men in the general population. Unlike bulimia nervosa, binge eating disorder occurs most commonly among overweight and obese people and contributes to excessive caloric intake; it may be present in 30% of patients in some weight reduction programs. Compared with people with anorexia nervosa or bulimia nervosa, those with binge eating disorder are older and more likely to be male.

People with binge eating disorder are distressed by it. Clinical depression and preoccupation with body shape, weight, or both are more common in obese people with binge eating disorder than in obese people who are not binge eaters.

Diagnosis

  • Clinical criteria

Clinical criteria for diagnosis require binge eating for once/wk for at least 3 mo and a sense of lack of control over eating, plus the presence of 3 of the following:

  • Eating much more rapidly than normal

  • Eating until feeling uncomfortably full

  • Eating large amounts of food when not feeling physically hungry

  • Eating alone because of embarrassment

  • Feeling disgusted, depressed, or guilty after overeating

Binge eating disorder is differentiated from bulimia nervosa (which also involves binge eating) by the absence of compensatory behaviors (eg, self-induced vomiting, use of laxatives or diuretics, excessive exercise, fasting).

Treatment

  • Cognitive-behavioral therapy (CBT)

  • Sometimes interpersonal psychotherapy (IPT)

  • Consideration of drug therapy with SSRIs or weight-loss drugs

CBT is the most researched and best supported treatment. Both CBT and IPT result in remission rates of 60%; improvement is usually well-maintained over the long-term. These treatments do not produce significant weight loss in obese patients.

Conventional behavioral weight loss treatment has short-term effectiveness in reducing binge eating, but patients tend to relapse. Antidepressant drugs also have short-term effectiveness in eliminating binge eating, but long-term effectiveness is unknown. Appetite-suppressing drugs (eg, topiramate) or weight-loss drugs (eg, orlistat) may be additionally helpful.

Drugs Mentioned In This Article

  • Drug Name
    Select Trade
  • TOPAMAX
  • ALLI, XENICAL

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