(See also Introduction to Eating Disorders.)
Binge-eating disorder affects about 3.5% of women and 2% of men in the general population during their lifetime. 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.
Symptoms and Signs
During a binge episode, people eat a much larger amount of food than most people would eat in a similar time under similar circumstances. During and after a binge, people feel as if they have lost control. Binge eating is not followed by purging (by inducing vomiting, misusing laxatives, diuretics, or enemas), excessive exercising, or fasting. Binge eating occurs in episodes; it does not involve constant overeating ("grazing").
People with binge-eating disorder are distressed by it. Mild to moderate depression and preoccupation with body shape, weight, or both are more common in obese people with binge-eating disorder than in people of similar weight who do not binge eat.
Diagnosis
Clinical criteria for diagnosis of binge-eating disorder require that
In addition, ≥ 3 of the following must be present:
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 is the most studied and best supported treatment for binge-eating disorder. But interpersonal psychotherapy appears equally effective; both result in remission rates of ≥ 60%, and 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 (eg, SSRIs) also have short-term effectiveness in eliminating binge eating, but long-term effectiveness is unknown. Lisdexamfetamine is approved for the treatment of moderate to severe binge-eating disorder. It can reduce the number of binge days and appears to cause slight weight loss, but its long-term effectiveness is unknown. Appetite-suppressing drugs (eg, topiramate) or weight-loss drugs (eg, orlistat) may be helpful.
Key Points
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People with binge-eating disorder tend to be overweight and obese.
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Diagnose binge-eating disorder based on clinical criteria (including binge eating, on average, at least once/week for 3 months, with a sense of lack of control over eating).
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Treat with cognitive-behavioral therapy or interpersonal psychotherapy and sometimes drugs (eg, SSRIs, lisdexamfetamine).
