Binge Eating Disorder

BED Basics - Defining the Binge

• Recurrent episodes: eating unusually large food amount in discrete period (e.g., 2-hour) with loss of control.
• Binge episodes include ≥3: eating rapidly; uncomfortably full; large amounts if not hungry; eating alone (embarrassment); post-binge disgust/guilt.
• Frequency: ≥once/week for 3 months.
• Marked distress regarding binge eating.
• No inappropriate compensatory behaviors (vs. Bulimia Nervosa).

⭐ BED is the most common eating disorder.

• Epidemiology: Prevalence 2-3%; onset late adolescence/early adulthood. F:M ≈ 3:2. Rising in India.

Diagnosis Decoded - Spotting the Signs

DSM-5 Criteria for Binge Eating Disorder (BED):

• Recurrent binge eating episodes:
  • Eating unusually large food amount in a discrete period (e.g., 2 hours).
  • Sense of lack of control during the episode.
• Episodes include ≥3 of the following (📌 Mnemonic: FEEDS - Feeling disgusted, Eating rapidly/alone, Embarrassment, Distress, Speed/Size of meal):
  • Eating rapidly.
  • Eating until uncomfortably full.
  • Eating large amounts when not hungry.
  • Eating alone due to embarrassment.
  • Feeling disgusted/depressed/guilty afterward.
• Marked distress regarding binge eating.
• Occurs at least once a week for 3 months.
• No regular compensatory behaviors (e.g., purging, fasting).

⭐ BED is distinct from Bulimia Nervosa due to the absence of regular inappropriate compensatory behaviors.

Causes & Clinic - Unpacking BED

• Etiology: A Biopsychosocial Mix
  • Genetic: Family history ↑ risk.
  • Neurobiological:
    • Serotonin (↓) & Dopamine pathway dysregulation (reward seeking).
  • Psychological:
    • Impulsivity, negative affect (poor emotional regulation).
    • Childhood trauma/obesity as risk factors.
• Clinical Presentation:
  • Often associated with obesity (BMI ≥ 30 kg/m²), but not diagnostic.
  • History of weight cycling (yo-yo dieting).
  • Significant psychological distress (guilt, shame post-binge).
• Common Comorbidities: (📌 Mnemonic: All Day Munching Provokes Sadness & Sickness)
  • Anxiety disorders (GAD, social phobia)
  • Depression (MDD)
  • Metabolic syndrome & Type 2 DM
  • Personality disorders (e.g., BPD)
  • Substance use disorders
  • Stress/Trauma-related disorders (PTSD)

⭐ High comorbidity with mood (depression) and anxiety disorders is a hallmark of BED.

Treatment & Outlook - Managing the Munchies

• Psychotherapy (Core Treatment):
  • Cognitive Behavioral Therapy for BED (CBT-BED): First-line, targets dysfunctional thoughts & behaviors.
  • Interpersonal Psychotherapy (IPT): Focuses on interpersonal issues contributing to BED.
• Pharmacotherapy (Consider if psychotherapy insufficient/severe):
  • Lisdexamfetamine dimesylate: 30-70 mg/day (Vyvanse).

    ⭐ Lisdexamfetamine is the only FDA-approved medication specifically for moderate to severe BED in adults.

  • SSRIs: e.g., Fluoxetine (40-80 mg/day), Sertraline. May reduce binge frequency.
  • Topiramate: (Off-label, anti-epileptic) Weight loss benefit, but cognitive side effects.
• Lifestyle: Structured meal plans, regular physical activity, stress management.
• Prognosis & Complications:
  • Remission rates vary; sustained recovery is achievable.
  • Relapse factors: Stress, comorbid conditions (depression, anxiety).
  • Long-term: ↑Risk of obesity, Type 2 DM, HTN, dyslipidemia, psychological distress.

High-Yield Points - ⚡ Biggest Takeaways

• Recurrent binge eating episodes with loss of control, without compensatory behaviors.
• ≥3 associated features: eating rapidly, eating until uncomfortably full, eating large amounts when not hungry, eating alone, post-binge guilt.
• Occurs at least once a week for 3 months.
• Marked distress regarding binge eating; often associated with obesity.
• Absence of inappropriate compensatory behaviors (key difference from Bulimia Nervosa).
• Treatment: Psychotherapy (CBT, IPT) first-line; SSRIs or lisdexamfetamine may be used.