Binge-Eating Disorder

Aka: Binge-Eating Disorder, Binge Eating, Compulsive Overeating, Overeating

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II. Diagnosis: Binge-Eating Disorder (DSM-5)

  1. Recurrent Binge Eating (eating more than peers in a 2 hour period) with a sense of loss of control
  2. No behaviors to prevent weight gain
    1. Contrast with Bulimia Nervosa
  3. Weekly behaviors (3 months or more)
    1. Fast eating, uncomfortable after eating, eating large quantities when not hungry
    2. Embarrassed about Overeating (e.g. eating alone due to embarrassment)
    3. Guilt or depression related to Binge Eating
  4. Severity
    1. Mild: 1 to 3 episodes per week
    2. Moderate: 4 to 7 episodes per week
    3. Severe: 8 to 13 episodes per week
    4. Extreme: >14 episodes per week

III. Findings: Compulsive Overeating

  1. Uncontrolled consumption of large food amounts
  2. Eat for relief, comfort, nurturing
    1. Stress
    2. Boredom
    3. Fear
    4. Loneliness
  3. Plan the Next meal while eating this one
  4. Eat more than you want, or out of control with food
    1. Binge Eating
      1. Excessive intake per 2 hour period
    2. Grazing
      1. Large food intake throughout day, no planned meals
    3. Guilt and fear about not being able to stop eating
    4. Eat until feeling uncomfortably full
  5. Surreptitious eating
    1. Eating alone because of shame about excessive eating
  6. Sense of being fat or obese, or fear of becoming so
  7. Sought help or attempted methods to control weight
    1. Strict dieting or Fasting
    2. Self-induced Vomiting
    3. Laxatives or Diuretics
    4. Diet pills
    5. Vigorous Exercise
  8. Frequent weight fluctuations exceeding 10 pounds

IV. Differential Diagnosis

  1. Bulimia Nervosa (contrast with no compensatory purging in binge-eating)

V. Management

  1. Binge-Eating cessation
    1. Cognitive Behavioral Therapy
      1. Preferred first-line behavioral intervention
    2. Interpersonal psychotherapy
      1. Evaluate past and current symptoms
      2. Relate symptoms to patient's interpersonal and social context
    3. Self help programs
      1. May be used as adjuncts to formal therapy
  2. Manage comorbid Major Depression
    1. Selective Serotonin Reuptake Inhibitors (SSRI)
      1. Sertraline, Citalopram and Escitalopram have most evidence for use
  3. Weight Reduction (in combination with Cognitive Behavioral Therapy)
    1. See Obesity Management
    2. Orlistat
      1. Grilo (2005) Biol Psychiatry 57:1193-1201 [PubMed]
    3. Sibutramine
      1. Appolinario (2003) Arch Gen Psychiatry 60:1109-16 [PubMed]
    4. Other agents to control binging and also assist with weight loss
      1. Topiramate
      2. Zonisamide
  4. Other agents
    1. Lisdexamfetamine (Vyvanse)
      1. Consider in adults with >3 days of Binge Eating per week, refractory to other agents
      2. Postulated to act at Dopamine-based reward centers
      3. Dosing starts at 30 mg daily and titrate weekly to 50 to 70 mg daily
      4. (2015) Presc Lett 22(3):17

VI. Complications

  1. Complications related to Obesity (present in 71% of cases)
  2. Metabolic Syndrome and Type II Diabetes Mellitus
  3. Osteoarthritis
  4. Gastrointestinal symptoms
    1. Gastroesophageal Reflux
    2. Altered stool habits (Constipation, Diarrhea)
    3. Abdominal Bloating

VII. References

  1. Renbarger and Pearson (2021) Crit Dec Emerg Med 35(8): 17-23
  2. Klein (2021) Am Fam Physician 103(1): 22-32 [PubMed]

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