Binge-Eating Disorder

Binge Eating Disorder (BED) is a mental disorder characterized by episodes of consuming food in a larger amount than is normal in a short time.

Epidemiology
Prognosis
Comorbidity

Obesity, diabetes, hypertension, and chronic pain are common comorbid conditions.

Risk Factors
Criterion A

Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

  1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
  2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
Criterion B

The binge-eating episodes are associated with at least 3 of the following:

  1. Eating much more rapidly than normal.
  2. Eating until feeling uncomfortably full.
  3. Eating large amounts of food when not feeling physically hungry.
  4. Eating alone because of feeling embarrassed by how much one is eating.
  5. Feeling disgusted with oneself, depressed, or very guilty afterward.
Criterion C

Marked distress regarding binge eating is present.

Criterion D

The binge eating occurs, on average, at least 1 time per week for 3 months.

Criterion E

The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

  • In partial remission: After full criteria for binge-eating disorder were previously met, binge eating occurs at an average frequency of less than one episode per week for a sustained period of time.
  • In full remission: After full criteria for binge-eating disorder were previously met, none of the criteria have been met for a sustained period of time.
Severity Specifier

The minimum level of severity is based on the frequency of episodes of binge eating (see below). The level of severity may be increased to reflect other symptoms and the degree of functional disability.

  • Mild: 1-3 binge-eating episodes per week.
  • Moderate: 4-7 binge-eating episodes per week.
  • Severe: 8-13 binge-eating episodes per week.
  • Extreme: 14 or more binge-eating episodes per week.
    • Binge eating disorder differs from bulimia nervosa in that there are no compensatory behaviors (e.g. - laxative misuse, fasting, or self-induced vomiting) after eating to prevent weight gain
    • Anxiety disorders are associated with binge eating; however, the individual only receives a diagnosis of binge eating disorder when binging episodes occur every week for 3 months
  • Kleine-Levin syndrome
    • Episodes of binges associated with excessive sleep
    • Episodes of binges occur during the mood episodes only and are associated with other symptoms of a mood disorder

Cognitive behavioural therapy (CBT) is the first-line treatment for binge-eating disorder.[1][2] Interpersonal therapy (IPT) can also be considered, and has some evidence.[3]

Do not offer medication as the sole treatment for binge eating disorder. There is some evidence for lisdexamfetamine, second-generation antipsychotics, and topiramate.[4]

Eating Disorder Guidelines

Guideline Location Year PDF Website
International Comparison (Curr Opin Psychiatry) International 2017 - Link
Canadian Clinical Practice Guidelines (Children and Adolescents) Canada 2020 - Link
National Institute for Health and Care Excellence (NICE) UK 2017 - Link
American Psychiatric Association (APA) USA 2006, 2012 - Guideline (2006)
Guideline Watch (2012)
Quick Reference