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Binge-Eating Disorder

By

Evelyn Attia

, MD, Columbia University Medical Center, New York State Psychiatric Institute;


B. Timothy Walsh

, MD, College of Physicians and Surgeons, Columbia University

Last full review/revision Jun 2020| Content last modified Jun 2020
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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 or lisdexamfetamine.

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

Clinical criteria for diagnosis of binge-eating disorder require that

  • Binge eating occurs, on average, at least once/week for 3 months

  • Patients have a sense of lack of control over eating

In addition, 3 of the following must be present:

  • 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

  • Sometimes interpersonal psychotherapy

  • Consideration of drug therapy, usually selective serotonin reuptake inhibitors (SSRIs) or lisdexamfetamine

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

  • People with binge-eating disorder tend to be overweight and obese.

  • 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).

  • Treat with cognitive-behavioral therapy or interpersonal psychotherapy and sometimes drugs (eg, SSRIs, lisdexamfetamine).

Drugs Mentioned In This Article

Drug Name Select Trade
TOPAMAX
ALLI, XENICAL
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