Binge Eating Disorder (BED) has been described as having recurrent overeating episodes without engaging in a compensatory method of purging (e.g., self-induced vomiting). Although overeating has existed for centuries and was observed among the Romans, the first documented medical case of BED was of Laura in 1949. Binge eating behavior was reported across obesity studies in the 1950s by Dr. Albert Stunkard, and by the 1980s it was determined that bulimia nervosa and binge eating disorder (which was then called “pathological overeating syndrome”) should be categorized as separate eating disorders. Likewise, it was important for medical professionals to distinguish between obese clients who engaged in binge eating and those individuals who did not engage in overeating behaviors. In 1992, the term “binge eating disorder” was coined and discussed in the International Journal of Eating Disorders. The current Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (1994) only identified binge eating episodes associated with bulimia nervosa and included proposed BED research criteria in the appendix. Individuals who presently meet the BED criteria discussed in the next section are diagnosed with “Eating Disorder Not Otherwise Specified.” However, it is expected that BED will receive a separate clinical diagnosis in the DSM-5 publication. Although a highly secretive disorder, some celebrities have admitted to struggling with binge eating disorder, including Kara DioGuardi, an American Idol judge, Victoria Beckham (Posh Spice from the Spice Girls rock band), and Monica Seles, a tennis star. In 2009, Monica Seles revealed how a violent attack led to a dysfunctional pattern of emotional eating to deal with her overwhelming stress: http://well.blogs.nytimes.com/2009/04/24/monica-seles-talks-about-binge-eating/.
The DSM-IV-TR research criteria for Binge Eating Disorder identify recurrent episodes of binge eating as the overarching behavioral component for the disorder. The overeating occurs within a discrete period of time (usually within a two-hour time span) and the binge represents more consumption than would be typical for most people in a similar situation. The binges may last longer than for bulimia nervosa, days rather than hours, for an individual with BED. Additionally, the binges are marked by a sense of feeling out of control over one's eating or how much food is consumed. Binge eating episodes need to include three or more of the following features to meet the criteria for a BED diagnosis: (1) eating more rapidly than normal, (2) eating until feeling uncomfortable—past the point of fullness, (3) eating large amounts of food despite not feeling hungry, (4) eating alone due to embarrassment about how much food one is eating, and (5) feeling disgusted with oneself, experiencing depressed mood or guilt after the binge eating episode. Individuals with BED report significant distress regarding the binge eating. On average, the binge eating episodes occur at least two days a week for at least six months. It is important to note that this duration is longer than for individuals with bulimia nervosa (i.e., three months). The final criterion for BED requires that binge eating episodes are not accompanied by inappropriate compensatory methods such as vomiting, laxative abuse, and excessive exercise. As a result of the frequent overeating, many individuals with BED struggle with overweight and obesity.
Approximately one-fifth to one-third of individuals who seek obesity treatment fit the criteria for BED. Seventy percent of individuals with BED in a community sample were obese and 20 percent of BED individuals had a body mass index over 40. BED is more common than either anorexia nervosa or bulimia nervosa. Approximately 3.5 percent of women and 2 percent of men reported having binge eating disorder at some point in their lives compared with only 0.9 percent of women with anorexia nervosa, 1.5 percent of women with bulimia nervosa or 0.5 percent of men with bulimia nervosa. There is some initial evidence that certain groups (e.g., football players) and minority populations (e.g., African American, Latino/Hispanic, Polynesian groups) may be considered at risk for developing Binge Eating Disorder due to sport demands and cultural traditions (e.g., overeating for family meals).
BED frequently occurs concurrently with mood and anxiety disorders and substance use. Studies have shown that up to 74 percent of BED individuals reported additional psychiatric disorders. In fact, individuals with BED were significantly more likely to have co-occurring psychiatric disorders than obese clients without BED. One study demonstrated that 60 percent of obese binge eaters met the criteria for one or more psychiatric disorders compared to only 28 percent of non–binge eaters of similar age and weight. Furthermore, binge eaters were more likely to struggle from an affective disorder (e.g., depression) than non–binge eaters with rates of 32 percent and 8 percent respectively. For binge eating individuals, major depressive episodes were often accompanied by weight gain.
Although binge eating individuals were more likely to have psychiatric problems compared to the general population, when examining individuals with anorexia nervosa or bulimia nervosa, individuals with BED were no more likely to have comorbid psychiatric conditions. While studies vary in terms of reported prevalence rates, approximately 36–44 percent of individuals who abused alcohol reported engaging in binge eating episodes.
Individuals who suffer from BED often experience the same health consequences associated with being overweight or obese. Being overweight or obese carries a higher risk for a number of damaging health conditions such as high blood pressure, high cholesterol, cardiovascular disease, and Type II diabetes. With increased rates of obesity come additional risks of bone and joint problems, respiratory problems, and stroke. Additionally, gall bladder disease is more common among obese individuals, and obese women have twice the rate of bowel or rectal cancer as individuals at a normal weight. Due to binge episodes triggered by psychological states, binge eating individuals experience difficulty in realizing fullness. They may also have difficulty in losing weight and in maintaining a normal or healthy weight for their height and age.
Binge Eating Disorder has become increasingly more recognized as an eating disorder separate from anorexia nervosa and bulimia nervosa. Although BED has been associated with obesity, not all obese individuals meet the clinical criteria for BED which is currently diagnosed as Eating Disorder Not Otherwise Specified. It is expected that BED will receive a separate clinical diagnosis in the next edition of the DSM.
See also: Anorexia Nervosa; Bulimia Nervosa; Eating Disorder Not Otherwise Specified.
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