Description

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.

Epidemiology

Incidence
The incidence of BED among women between 10 and 24 years of age was 35 per 100,000 person-years.

Prevalence

• 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.

Genetics

• 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.

Risk Factors

• 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.

General Prevention

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.