Binge Eating Disorder
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Binge eating disorder (BED) is characterized by episodes of uncontrollable consumption of large amounts of food in a discrete amount of time associated with a subjective sense of lack of control overeating. Unlike bulimia nervosa, BED is not associated with concurrent weight loss behaviors such as self-induced vomiting, excessive exercise, or the use of laxatives or diuretics.
The incidence of BED among women between 10 and 24 years of age was 35 per 100,000 person-years.
- Lifetime prevalence of BED in the United States and Western Europe of 1–3%
- Occurs in about 2–5% of the adult population
- More common in females than males
- 17–30% of individuals with BED have normal body weights.
- An estimated 1–2% of adolescents have BED.
- Mean age of onset for BED is 23.3 years.
- BED is seen in between 5% and 50% of patients seeking treatment for obesity. The severity of the psychopathy is not related to BMI.
Etiology and Pathophysiology
- Patients with BED likely have dysregulation of motivation of impulse control similar to that seen in other impulsive and compulsive disorders.
- Changes in dopaminergic and opioidergic neurotransmitter networks are associated with binge eating behaviors.
- Neuroimaging studies show corticostriatal circuitry changes in BED similar to those seen in substance abuse.
- BED has a familial heritability from 41% to 57%.
- BED has been shown to aggregate in families independent of obesity status.
- Specific dopamine receptor genetic polymorphisms have been associated with individuals with BED.
- BED is associated with obesity and with risk factors for psychiatric disorders.
- BED is associated with obesity and may confer the risk of components of metabolic syndrome.
Well-established risk factors for eating disorders, including BED, include an elevated perceived pressure to be thin, internalization of the thin-ideal standard of female beauty, body mass, body dissatisfaction, and negative affectivity.
Commonly Associated Conditions
- 30–80% of individuals with BED have lifetime comorbid mood or anxiety disorders.
- BED even below the threshold of BED is associated with suicidality. The relationship between BED and suicidality is much stronger in women relative to men.
- Other psychiatric comorbidities and personality disorders reported in individuals with BED or eating disorders include gambling problems, bipolar disorder, substance abuse, and avoidant, obsessive-compulsive disorder, and borderline personality disorders.