Binge eating disorder (BED) is part of a cluster of diagnoses called the feeding and eating disorders. Feeding and eating disorders are a group of psychiatric conditions that include:
Feeding and eating disorders are characterized by a persistent disturbance in eating behaviors. These disorders are linked to alterations in the consumption of food or absorption of nutrients, and can result in severe distress, physical health problems, and psychosocial impairment. People with anorexia nervosa are significantly underweight because they eat very little food in an effort to lose weight or prevent weight gain. People with binge eating disorder and bulimia nervosa eat large quantities of food in a short period of time (called a "binge"); people with bulimia nervosa also attempt to prevent weight gain by compensating for these binges in an inappropriate way, usually by vomiting, excessively exercising, fasting, or misusing laxatives or other medications. People with pica regularly eat non-nutritious, non-food substances. People with avoidant/restrictive food intake disorder have little interest in food or avoid many types of foods, which results in nutrition deficits.
Several of these disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder, are characterized by serious disturbances in body image and a preoccupation with weight and shape. Other disorders, including pica and avoidant/restrictive food intake disorder, are characterized by atypical eating behaviors but are not prominently associated with body image disturbances. Some feeding and eating disorders, including anorexia nervosa and avoidant/restrictive food intake disorder, cause the individual to be significantly underweight or malnourished as a result of their eating behaviors. Other disorders, including bulimia nervosa and binge eating disorder, do not produce marked weight loss and are typically associated with normal or higher than expected weight.
BED is a psychiatric disorder that affects approximately 1 - 2.5% of children and adolescents. BED is characterized primarily by recurrent episodes of binge eating, in which the person eats a very large amount of food in a discrete period of time (e.g., a two-hour period).
The definition of "a very large amount of food" is subjective, but is usually defined as an amount that is significantly greater than most individuals would eat in a similar situation. During these eating binges the person experiences a sense of loss of control (e.g., the feeling that he or she cannot stop eating).
For an individual to be diagnosed with BED, the eating binges must occur on average at least once per week and must be associated with three or more of the following:
Unlike bulimia nervosa, individuals with BED do not engage in inappropriate compensatory behaviors (e.g., self-induced vomiting; excessive exercise) after a binge. However, many individuals with BED routinely diet in an attempt to lose weight. To meet diagnostic criteria for BED, the individual must experience significant distress about their binge eating.
BED severity can range from mild to severe. In severe cases, BED can lead to impaired physical health, increased medical morbidity and healthcare utilization, obesity, and negative financial consequences. Individuals with BED may also experience impairment at work or school and in interpersonal relationships.
Many people with BED also have other psychiatric conditions, most commonly mood disorders, anxiety disorders, and substance use disorders.
BED is characterized by abnormalities of brain function which are thought to contribute to symptoms. In particular, neurobiological models suggest that regularly binging on palatable food may be related to alterations in the dopamine, acetylcholine, and opioid systems in reward-related brain areas, leading to the maintenance of binge eating. Dietary restriction in between binges is also thought to contribute to the desire to binge. The disorder is thought to have a genetic component, although having a predisposition to BED does not necessarily mean that someone will develop BED.
Little is known about the treatment of pediatric BED. However, published treatment guidelines for pediatric eating disorders, including BED, are provided by the American Academy of Child and Adolescent Psychiatry.
The following treatments have shown promise in clinical trials for treating pediatric BED:
In addition, the following treatments have shown some evidence of efficacy for treating adult BED. However, as these treatments have not been evaluated in pediatric samples, caution is warranted when considering these interventions:
In addition, research suggests that the following treatments are promising for treating adult BED. Again, caution is warranted when considering these interventions as they have not been evaluated in pediatric populations:
Additional Treatments to Consider
Preliminary evidence suggests that the following strategies, while not a substitute for the more well-validated treatments described above, have shown some promise in adult samples and may be considered for children and adolescents with BED:
The following treatments have shown promise in clinical trials for treating pediatric BED:
In addition, the following treatments have shown some evidence of efficacy for treating adult BED. However, as these treatments have not been evaluated in pediatric samples, caution is warranted when considering these interventions:
In addition, research suggests that the following treatments are promising for treating adult BED. Again, caution is warranted when considering these interventions as they have not been evaluated in pediatric populations:
Additional Treatments to Consider
Preliminary evidence suggests that the following strategies, while not a substitute for the more well-validated treatments described above, have shown some promise in adult samples and may be considered for children and adolescents with BED: