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 is preferred behavioral intervention
    2. Self help programs may also assist management
  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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Related Studies

Ontology: Hyperphagia (C0020505)

Definition (MSH) Ingestion of a greater than optimal quantity of food.
Definition (CSP) ingestion of a greater than optimal quantity of food.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D006963
ICD9 783.6
ICD10 R63.2
SnomedCT 206939001, 206940004, 206937004, 206941000, 267023007, 158289004, 158288007, 211764001, 267157001, 158290008, 158291007, 139084002, 161827002, 41522009, 58424009
English Hyperphagia, Overeating, HYPERPHAGIA, POLYPHAGIA, Polyphagia NOS, [D]Excessive eating, [D]Hyperalimentation, [D]Polyphagia, [D]Polyphagia NOS, [D]Excessive eating (context-dependent category), [D]Hyperalimentation (context-dependent category), [D]Polyphagia (context-dependent category), [D]Polyphagia NOS (context-dependent category), extreme overeating (symptom), extreme overeating (hyperphagia), hyperphagia, extreme overeating, Hyperalimentation NOS, Hyperphagia [Disease/Finding], gluttony, Over eating, overeat, excessive eating, hyperalimentation, hyperalimentation (diagnosis), Hyperalimentation, :: Polyphagia, [D]Excessive eating (situation), [D]Polyphagia (situation), Polyphagia (disorder), [D]Hyperalimentation (situation), Hyperalimentation (disorder), [D]Polyphagia NOS (situation), Polyphagias, Polyphagia, Excessive eating, Overeats, Excessive eating - polyphagia, Excessive eating - polyphagia (finding), Overeating (finding), Gluttony, overeating, polyphagia, eating; excess, excessive; eating, Hyperalimentation, NOS, Overeating, NOS, Excessive eating, NOS, Hyperalimentation (disorder) [Ambiguous], over eating
French HYPERPHAGIE, POLYPHAGIE, Polyphagie, Hyperphagie, Alimentation excessive
German HYPERPHAGIE, Polyphagie, exzessives Essen, POLYPHAGIE, Hyperphagie, Überessen
Dutch overmatig eten, polyfagie, eten; overmaat, overmatig; eten, Polyfagie, hyperfagie, Hyperfagie, Overeten
Italian Eccesso nel mangiare, Polifagia, Iperfagia
Portuguese Polifagia, Comer em excesso, HIPERFAGIA / BOLIMIA, POLIFAGIA, Alimentação em Excesso, Ingestão Excessiva de Alimentos, Hiperalimentação, Superalimentação, Hiperfagia
Spanish Polifagia, Comer en exceso, [D]hiperalimentación (categoría dependiente del contexto), [D]polifagia, SAI (categoría dependiente del contexto), [D]polifagia (categoría dependiente del contexto), [D]ingesta excesiva (categoría dependiente del contexto), POLIFAGIA, Alimentación en Exceso, [D]ingesta excesiva, alimentación excesiva, polifagia (trastorno), [D]hiperalimentación (situación), hiperfagia, gula, [D]hiperalimentación, polifagia, [D]polifagia, [D]ingesta excesiva (situación), [D]polifagia, SAI, ingesta excesiva de alimentos, hiperalimentación (trastorno), [D]polifagia, SAI (situación), hiperalimentación, [D]polifagia (situación), Ingestión Excesiva de Alimentos, Hiperalimentación, Sobrealimentación, comer en exceso (hallazgo), comer en exceso, hiperalimentación (concepto no activo), ingestión excesiva - polifagia (hallazgo), ingestión excesiva - polifagia, Hiperfagia
Japanese 過食, カショク, 摂食亢進症, 摂食高進, 多食症, 摂食亢進
Swedish Ätande, överdrivet
Czech přejídání, Hyperfagie, Polyfagie, Excesivní příjem potravy, hyperfagie, hyperfágie, obžerství
Finnish Ylensyöminen
Korean 다식증
Croatian Not Translated[Hyperphagia]
Polish Hiperfagia, Łaknienie nadmierne
Hungarian Polyphagia, Túlzott mértékű evés, Hyperphagia
Norwegian Overspising, Hyperfagi

Ontology: Binge eating disorder (C0596170)

Definition (MSH) A disorder associated with three or more of the following: eating until feeling uncomfortably full; eating large amounts of food when not physically hungry; eating much more rapidly than normal; eating alone due to embarrassment; feeling of disgust, DEPRESSION, or guilt after overeating. Criteria includes occurrence on average, at least 2 days a week for 6 months. The binge eating is not associated with the regular use of inappropriate compensatory behavior (i.e. purging, excessive exercise, etc.) and does not co-occur exclusively with BULIMIA NERVOSA or ANOREXIA NERVOSA. (From DSM-IV, 1994)
Definition (NCI) A disorder characterized by recurrent episodes of binge-eating over which the individual feels a lack of control and a sense of disgust and shame; unlike bulimia, however, there is no attempt to compensate for the binge-eating through vomiting or fasting.
Definition (PSY) Eating excessive quantities of food, often after stressful events. Compare BULIMIA.
Definition (CSP) episodes of binge eating with a sense of lack of control; most individuals exhibiting this behavior are obese and usually do not use compensatory behaviors (such as purging, fasting, misuse of laxatives and other medications, or excessive exercise) that are characteristic of bulimia nervosa.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D056912
ICD10 F50.2
SnomedCT 439960005, 40448009, 248122005
Italian Alimentazione incontrollata, Disturbo da alimentazione incontrollata
Spanish parrandear, parrandear (hallazgo), trastorno alimentario por atracón (trastorno), trastorno alimentario por atracón, Trastorno por Atracón, Atracón, episodios de ingestión compulsiva y excesiva (hallazgo), episodios de ingestión compulsiva y excesiva
Japanese キバラシグイ, むちゃ食い障害, 気晴らし食い, むちゃ食い, 気晴らし食い摂食障害, 気晴らし食い症候群
English eating binges (symptom), eating binges, eating binges (bulimic episodes), Binge eating disorder, Binge eating disorder (disorder), Binge-Eating Disorder, Disorder, Binge-Eating, Disorders, Binge-Eating, Binge-Eating Disorders, Hyperorexia nervosa, Binge-Eating Disorder [Disease/Finding], binging, binge disorders eating, binge, binge eating, bingeing, binge disorder eating, binge eating disorder, bing, binge-eating disorder, Binge Eating Disorder, BED, eating disorder binge, Binge eating disorder (diagnosis), Binge eating, Bingeing, Binges, Bouts of overeating, Episodes of overeating, Binging (finding), Binging, hyperorexia nervosa, Binge overeating, Binge Eating
Czech Záchvatovité přejídání, záchvaty přejídání, záchvatovité přejídání
French Boulimie sans compensation, Syndrome d'hyperphagie compulsive, Syndrome d'hyperphagie incontrôlée, Hyperphagie boulimique, Hyperphagie compulsive
German Binge-Eating -Störung, Binge-Eating -Stoerung, Fressattacke
Portuguese Transtorno da Compulsão Alimentar, Abuso da comida
Swedish Hetsätningsstörning
Polish Jedzenie żarłoczne, Żarłoczne jedzenie
Hungarian Binge eating
Norwegian Binge eating disorder
Dutch brassend eten

Ontology: compulsive overeating (C0814174)

Concepts Mental or Behavioral Dysfunction (T048)
English compulsive overeating