Investigating binge eating disorder

The American Psychiatric Association recently added a new condition - binge eating disorder - to their classification of eating disorders.

Characteristics of the new eating disorder.


The new Binge Eating Disorder has the following characteristics which are used to differentiate it from the more familiar eating disorders, such as anorexia and bulimia:
  • two or more episodes of binge eating per week for 6 or more months
  • no use of purging, fasting, or exercise to decrease weight, i.e. no so-called anti-obesity behaviours
  • patients suffer from 'loss of control' over their binge eating
  • eating faster than normal * eating very large quantities of food when not hungry
  • eating alone to avoid embarrassment
  • eating until uncomfortable
  • experiencing feelings of self-disgust after an eating binge
  • feeling guilty or depressed after an eating binge

Binge eating is defined as "The uncontrolled consumption of an unusually large quantity of food over a discrete time period".

Psychological components
Binge Eating Disorder is strongly associated with psychological problems. Patients are usually depressed and often suffer from anxiety, particularly panic disorder and post traumatic stress disorder.

Differences

Binge Eating Disorder differs from the standard binge eating that occurs in bulimia because it is not associated with any of the anti-obesity behaviours which characterise bulimia. While bulimics expend a great deal of effort on taking laxatives and diuretics, inducing vomiting, exercising excessively, and even taking slimming pills to counteract their uncontrolled eating, individuals suffering from Binge Eating Disorder do nothing to counteract their unnatural food intake.

How common is Binge Eating Disorder?

According to a report in the May/June 2000 edition of Psychiatry, about 1% of women in a study conducted in the USA had the symptoms of Binge Eating Disorder. The incidence is slightly lower in European countries and in men.

Who is likely to develop Binge Eating Disorder?

A troubling finding of studies investigating this new disorder, is that in patients who attend slimming clinics or use weight-loss programmes, the incidence of Binge Eating Disorder rises to a startling 30%. Obese people are also much more likely to develop this disorder than thin people.

In another study, 21% of overweight female subjects suffered from Binge Eating Disorder compared to 9% of women with normal body weight.

In other words, people who experience problems with body weight, who suffer from obesity and who attempt to lose weight, are all exposed to the risk of developing Binge Eating Disorder. Women appear to be much more susceptible to this disorder than men.

Associated health problems

Studies have also shown that people with Binge Eating Disorder often suffer from obesity-related health problems, such as non-insulin-dependent diabetes mellitus, heart disease, high blood cholesterol levels, cancer and sleep apnoea. When this spectrum of illnesses and the psychological problems associated with Binge Eating Disorder are combined, such patients have a very poor quality of life.

Treatment

Because of the characteristics of this disorder, and the attendant physical and psychological problems, patients suffering from Binge Eating Disorder should receive concurrent treatment by an expert team consisting of a physician, a psychiatrist and/or clinical psychologist, and a dietitian.

At the present moment, experts agree that the most important goal of treatment is to firstly eliminate binge eating and normalise eating habits before attempting to address weight-loss.

The goal is to help patients to establish a regular meal pattern using standard size meals without any snacks. Once such a balanced eating pattern has been reinstated, patients will probably start to lose weight. To boost weight-loss after rehabilitation, patients are usually encouraged to do plenty of exercise rather than to diet, as this may trigger binge eating again.

Do you suffer from uncontrolled eating binges which cause depression and anxiety? Are you trying to diet and alternate periods of starvation with periods of gorging? If you answer "Yes" to any of these questions, then you may be at risk of developing Binge Eating Disorder.

Next week we will have a look at other aspects of treatment and how one can try and prevent Binge Eating Disorder. - (Dr I van Heerden, DietDoc)

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