what is binge-eating disorder (BED)?

A binge is defined as the uncontrolled consumption of an unusually large quantity of food over a discrete period of time.

Binge-eating disorder (BED) is a syndrome that resembles bulimia nervosa and is characterised by episodes of uncontrolled eating, eating more rapidly than normal, eating alone, feeling disgusted, depressed or guilty after over-eating and eating large amounts of food when not feeling physically hungry. BED differs from bulimia nervosa in that sufferers don’t engage in purging activities, like vomiting or laxative abuse.

Binge-eating disorder was identified in 1959, but was only included as a medical diagnostic category in need of further research, in 1994.

Who gets BED?
Between 15% and 50% of persons in weight-control programmes suffer from BED and sufferers are 1.5 times more likely to be women than men. Binge-eating occurs in 21% of overweight women. However, regardless of a person’s weight, it is typical for a BED sufferer to feel overweight and to have a history of fruitless attempts to lose weight. The onset of binge-eating is often closely associated with dieting, occurring in late adolescence. It is found most often in Caucasians but also in other ethnic groups. One-third to one-fourth of all patients with binge-eating disorder is male.

Risk factors

• Obsession with dieting
• Preoccupation with a thin and slim body
• Familial predisposition (genetic vs. environmental factors)
• Personality traits: low self esteem, difficulty with self regulation, body image problems, fears about separation and a tendency to be a perfectionist and distrustful
• Combination of some or all of the above
• Obesity

Complications of BED

• Obesity: increase of 20% of normal body weight
• High incidence of psychiatric illness, especially depression
• Increased risk to suffer from the following:
  • High blood pressure
  • Diabetes
  • High cholesterol
  • Higher risk for gallbladder disease
  • Heart disease
  • Some types of cancer

Treatment guidelines

• Firstly, a sufferer must admit that there is a problem for treatment to be effective.
• Consult a trained counsellor, psychologist or psychotherapist.
• Self-help groups and the support of family and friends is important.
• Pharmacological interventions, e.g. SSRI or Tricyclic Antidepressants may be considered in combination with psychotherapy.
• Nutritional/ Dietary Guidance

Treatment options
Cognitive Behaviour Therapy (CBT)

• group therapy for out-patients
• individual therapy for in-patients and out-patients

Behaviour and/or Interpersonal Therapy
Pharmacotherapy

• Antidepressants may be useful but are not yet registered for binge eating disorder
• Drugs include SSRI’s such as fluoxetine and fluvoxamine; and tricyclic antidepressants, such as imipramine.

Nutritional/Dietary Guidance

• Medical nutrition therapy provided by a registered dietician trained in eating disorders is an important part of the multi-disciplinary treatment approach.
• The dietician must understand the complexities of eating disorders, such as comorbid illness, medical and psychological complications, and boundary issues.