Binge eating disorder (BED) is the most common eating disorder in the United States affecting 3.5% of females and 2% of males and is prevalent in up to 30% of those seeking weight loss treatment. Although it is not yet classified as a separate eating disorder, it was first described in 1959 by psychiatrist and researcher Albert Stunkard as "Night Eating Syndrome" (NES), and the term "Binge Eating Disorder" was coined to describe the same binging-type eating behavior without the nocturnal component. BED usually leads to obesity although it can occur in normal weight individuals. There may be a genetic inheritance factor involved in BED independent of other obesity risks and there is also a higher incidence of psychiatric comorbidity, with the percentage of individuals with BED and an Axis I comorbid psychiatric disorder being 78.9% and for those with subclinical BED, 63.6%.
- Periodically does not exercise control over consumption of food.
- Eats an unusually large amount of food at one time, far more than a normal person would eat in the same amount of time.
- Eats much more quickly during binge episodes than during normal eating episodes.
- Eats until physically uncomfortable and nauseated due to the amount of food just consumed.
- Eats when depressed or bored.
- Eats large amounts of food even when not really hungry.
- Usually eats alone during binge eating episodes, in order to avoid discovery of the disorder.
- Often eats alone during periods of normal eating, owing to feelings of embarrassment about food.
- Feels disgusted, depressed, or guilty after binge eating.
- Rapid weight gain, and/or sudden onset of obesity.
 Relationship to other eating disorders
Binge eating symptoms are also present in bulimia nervosa. The formal diagnosis criteria are similar in that subjects must binge at least twice per week for a minimum period of three months for bulimia nervosa and a minimum of 6 months for BED. Unlike in bulimia, those with BED do not purge, fast or engage in strenuous exercise after binge eating. Additionally, bulimics are typically of normal weight, are underweight but have been overweight before, or are slightly overweight. Those with binge eating disorder are more likely to be overweight or obese.
Binge eating disorder is similar to, but distinct from, compulsive overeating. Those with BED do not have a compulsion to overeat and do not spend a great deal of time fantasizing about food. On the contrary, some people with binge eating disorder have very negative feelings about food. As with other eating disorders, binge eating is an "expressive disorder"'a disorder that is an expression of deeper psychological problems. Some researchers believe BED is a milder form or subset of bulimia nervosa, while others argue that it is its own distinct disorder. Currently, the DSM-IV categorizes it under Eating disorder not otherwise specified (EDNOS), an indication that more research is needed.
 Occurrence and risk factors
Most people with this problem are either overweight or obese, but people of normal weight can also have the disorder.
About two percent of all adults in the United States (as many as four million Americans) have binge eating disorder. About ten to fifteen percent of people who are mildly obese and who try to lose weight on their own or through commercial weight-loss programs have binge eating disorder. The disorder is even more common in people who are severely obese.
Binge eating disorder is twice as common among women as among men. The disorder is found in all ethno-cultural and racial populations. People who are obese and have binge eating disorder often became overweight at a younger age than those without the disorder. They might also lose and gain back weight more often, or be paranoid about gaining weight.
No one knows for sure what causes binge eating disorder. As many as half of all people with binge eating disorder have been depressed in the past. Whether depression causes binge eating disorder, whether binge eating disorder causes depression, or whether the two have a common cause, is not known for sure.
The trigger point can be emotion such as happiness, anger, sadness or boredom. Impulsive behavior and certain other emotional problems can be more common in people with binge eating disorder. However, many people also claim that bingeing occurs regardless of their mood. It is also unclear whether dieting and binge eating are related. Some studies show that about half of all people with binge eating disorder had binge episodes before they started to diet.
Researchers also say that binge eating disorder is more common among competitive athletes such as swimmers or gymnasts whose body form is regularly on public display. Affected athletes in these sports tend to compare their own bodies in a negative way with those of their teammates. There is a research into how brain chemicals and metabolism affect binge eating disorder, but this study is in its early stages.
While people tend to overeat from time to time, a consistent habit of frequent consumption of large amounts of food in a short period of time usually leads to weight gain and obesity. The most problematic health consequences of this type of eating disorder is brought on by the weight gain resulting from the bingeing episodes.
People with binge eating disorder may become ill due to a lack of proper nutrition. Bingeing episodes usually include foods that are high in fat, sugar, and/or salt, but low in vitamins and minerals. Individuals are usually very upset about their binge eating and may become depressed. Those who are obese and also have binge eating disorder are at risk for type 2 diabetes, high blood pressure (hypertension), high blood cholesterol levels (hypercholesterolemia), gallbladder disease, heart disease, and certain types of cancer.
Most people with binge eating disorder have tried to control it on their own, but have not been able to control it for very long. Some people miss work, school, or social activities to binge eat. Obese people with binge eating disorder often feel bad about themselves and may avoid social gatherings. Those who binge eat, whether obese or not, feel ashamed, are well aware of their disordered eating patterns, and try to hide their problems. Often they become so good at hiding it that even close friends and family members are unaware that they binge eat. Some of the most common symptoms are:
- Eating large amounts of food, even when not physically hungry. Eating more rapidly than usual.
- Eating until uncomfortably full.
- Eating alone out of embarrassment at the quantity of food being eaten.
- Feelings of disgust, depression, or guilt after eating.
People who are not overweight should avoid dieting because it sometimes makes their binge eating worse. Dieting here means skipping meals, not eating enough calories each day, or avoiding certain kinds of food, such as carbohydrates or fats. Many people with binge eating disorder are obese and have health problems because of their weight. People with binge eating disorder who are obese may find it harder to stay in a weight-loss program. They also may lose less weight than other people, and may regain weight more quickly due to a slowing of the metabolism. (This can be worse when they also have problems like depression, trouble controlling their behavior, and problems dealing with other people.) These people may need treatment for binge eating disorder before they try to lose weight. Dieting is usually not successful for those with BED, as they will usually gain back all of the weight lost, and sometimes more. Those with BED have more difficulty adhering to traditional weight-loss treatment.
People with binge eating disorder, whether or not they want to lose weight, should seek help from health professionals including physicians, nutritionists, psychiatrists, psychologists, clinical social workers or by attending 12-step Overeaters Anonymous meetings. Even those who are not overweight are usually upset by their binge eating, and treatment can help them.
Although mental health professionals may be attuned to the signs of binge eating disorders, most physicians do not raise the question, either because they are uninformed about the condition or too embarrassed to ask about it. Because it is not a recognized psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders, it is difficult to obtain insurance reimbursement for treatments.
There are several different ways to treat binge eating disorder. Cognitive-behavioral therapy teaches people how to keep track of their eating and change their unhealthy eating habits. It also teaches them how to change the way they act in tough situations. Interpersonal psychotherapy helps people look at their relationships with friends and family and make changes in problem areas. Drug therapy, such as antidepressants, may be helpful for some people.
Researchers are still trying to find the treatment that is the most helpful in controlling binge eating disorder. The methods mentioned here seem to be equally helpful. For people who are overweight, a weight-loss program to improve health and to build self-esteem, as well as counselling to pinpoint the root of the psychological problems triggering their binge episodes, might be the best choice.
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