What is Binge Eating?
Binge Eating Disorder ( BED ), also called binge eating disorder , is an eating disorder (DCA) proper.
This is not an occasional binge , because it affects at least 1-3 times a week and for at least 3 months, and should not be confused with the poor but conscious nutritional hygiene typical of the very obese, because it implies a component of ” discontrol ” – it should however differentiated from BN, which imposes the ability to compensate with purgation methods.
Binge eating: how many people suffer from it?
Potentially, anyone can develop binge eating disorder, regardless of ethnicity, gender, age, or weight.
In the United States it is considered to be the most widespread DCA, while in Italy the data is scarcer.
Although women are more likely to contract it, compared to what happens in Anorexia Nervosa (AN) and Bulimia Nervosa (BN), the male sex is very involved , with a prevalence estimated at approximately 40% – compared to 10-15% in BN and 5-10% of the AN (data may change over time).
In the USA, more than 6 million Americans – 2% of men and 3.5% of women – have suffered, suffer or will suffer from binge eating.
It is believed that this disorder mainly affects between the second and third decade of life , however, retrospective investigations have revealed that the loss of control over eating begins much earlier than diagnosis and generally before the age of twenty. This time lapse between onset and diagnosis could partly explain the tendency towards chronicity of the disorder.
Men are more likely to suffer from it in middle age . Among adolescents, 1.6% suffer from binge eating disorder.
Its prevalence grows in parallel with the degree of overweight ; studies carried out on the general population in Italy demonstrate that the prevalence of the disorder is estimated between 0.7% and 4.6%, while other works carried out in the United States report an incidence of 5% in obese people in the general population, 10- 15% of obese people use commercial weight loss programs , 30% of obese people seek treatment for obesity in specialist centers, and – in subjects intending to undergo bariatric surgery – the disorder could exceed 50%.
What it consists of and how to recognize binge eating disorder
The subject affected by binge eating is affected by recurrent episodes of binge eating . These binges are not just “big eats”, but have distinctive features.
Observing the course, it seems obvious that the quantity of food consumed is decidedly greater than normal, especially considering that this occurs over a limited period of time .
Therefore, the BED binge can: occur even in the absence of hunger , be much faster than normal, continue until you feel uncomfortably full . Furthermore, very often the binge happens in total solitude , due to the sense of embarrassment that it triggers in the subject.
The binge eater who binge experiences a real sense of loss of control during the episode (for example, the feeling of not being able to stop eating or control what or how much one is eating).
Sometimes, after the event, the dominant emotion is self – disgust , accompanied by depressive symptoms , or a strong sense of guilt .
It is therefore obvious that the subject suffering from binge eating constantly experiences negative emotions, or in any case strong discomfort linked to binge eating .
According to the DSM-V (diagnostic and statistical manual of mental disorders), to be defined as such, the binge eater must engage in binge eating at least 1 day a week for 3 months – the previous version suggested at least 2 times a week for 6 months.
Unlike what is expected in the bulimic attitude, in binge eating regular compensation methods do not occur (e.g. purging, fasting, excessive physical exercise, self-induced vomiting).
For information, we remind you that the severity of binge eating can be classified into 4 degrees :
- Mild : 1 to 3 episodes per week;
- Moderate : 4 to 7 episodes per week;
- Severe : 8 to 13 episodes per week;
- Extreme : 14 or more episodes per week.
To know more:Symptoms of Binge Eating Disorder
Causes of binge eating: why do we binge?
There are numerous studies on the risk factors and triggers for binge eating, but none offer completely exhaustive answers, even though the multifactorial theory which includes:
- Genetic factors;
- Neuroendocrine factors;
- Developmental and affective factors;
- Social factors.
Among these, difficult childhood life experiences , the presence of depressive disorders in parents , the tendency towards obesity and repeated exposure to negative comments regarding shape, weight and eating habits seem to play a fundamental role.
Binge eating could represent an escape or an emotional and thought block in the face of an emotional state considered intolerable, or represent a difficulty in managing impulses .
Similarly, binge eating can trigger other impulse-related behaviors such as alcoholism , drug addiction , self-harm , kleptomania and sexual promiscuity .
From a psychopathological point of view, the polarization of thoughts on food, weight and physical appearance does not seem as strong as in other eating disorders.
In-depth studies demonstrate that binge eating has specific genetic correlates , a peculiar socio-demographic distribution between sexes and different ethnic groups, and a high comorbidity with depression .
The correlation between binge eating, obesity and attempts to reduce weight is yet to be precisely defined; based on studies, excess weight and the consequent use of dietary therapies, which regularly occurs, could be a simple consequence of the pathological manifestation, and not a risk factor as happens with BN.
There are not many studies on genetic influences on binge eating, but some data indicate that the prevalence of the disorder is higher in individuals who have at least one first-degree relative suffering from this same pathology (60%), compared to families in which this is absent (5%).
Small-scale research has not demonstrated familial tendencies or a significant relationship between binge eating and other eating or psychiatric disorders.
In another study in which over 8000 Norwegian twins of both sexes were evaluated, binge eating appears to be influenced almost equally by genetic (41%) and environmental factors (59%), with a slight prevalence of the latter.
In a molecular genetic study on a sample of 469 obese people, 24 of whom had a mutation of the melanocortin-4 receptor, it was demonstrated that all subjects carrying this alteration tested positive for the diagnosis of binge eating.
For years, research has also focused on the possible influence of hormonal factors in the pathogenesis of binge eating, among which the most scrutinized are insulin , adiponectin , leptin and ghrelin , and cannabinoids.
The first studies on family binge eating styles compared 43 binge eaters with 88 subjects suffering from other eating disorders using the Family Environmental Scale; Binge Eating Disorders obtained lower scores regarding family cohesion, expressed emotion, active enjoyment, personal independence; vice versa, they report higher levels of conflict and interfamily control.
Compared to other subjects suffering from other eating disorders, binge eaters had a lower cultural level .
Among the psychosocial factors capable of influencing the onset of the disease, the most highlighted were concern and dissatisfaction with body image or weight and the frequent use of slimming diets.
These factors explain 61-72% of the variance in symptoms in men and 70% in women.
How to cure binge eating?
There is little data in the literature regarding the treatment of binge eating and the effectiveness of the therapies used.
It should be noted that, in the short term, the frequency of binge eating decreases significantly in response to pharmacological therapy with antidepressants and various forms of psychotherapy such as:
- CBT (cognitive behavioral therapy);
- IPT (interpersonal therapy) group;
- behavioral therapy of obesity;
- self-help with manuals.
However, reducing binge eating is not necessarily associated with a significant reduction in weight. It can be very important to collaborate with a dietitian , preferably one specialized in eating disorders, in order to intervene “pragmatically” on one of the most important causes of psychological distress (obesity), and to improve the collective state of health and life quality.
- Adami, G.F., Gandolfo, P., Bauer, B., and Scopinaro, N. (1995) Binge eating in massively obese patients undergoing bariatric surgery; International Journal of Eating Disorders; 17: 45–50.
- American Psychiatric Association (1994); Translators: Antonella Armani, Piera Fele, Mauro Mauri, Massimo Rossi, Francesco J. Scarsi; –TR translators: Susanna Banti, Mauro Mauri; Diagnostic and Statistical Manual of Mental Disorders; 624-637; 834-835.
- Branson, R., Potoczna, N., Kral, J. G., Lentes, K., Hoehe, M. R., and F.F. Horber (2003) Binge Eating as a Major Phenotype of Melanocortin-4 Receptor Gene Mutations; The New England Journal of Medicine; 20 March; 348; 12: 1096-1102.
- Bulik C.M., Tozzi F., Anderson C., Mazzeo S.E., Aggen S., and Sullivan P.F. (2003) The relation between eating disorders and componentsof perfectionism; American Journal of psichiatry; 160: 366-368.
- Claes L., Nederkoorn C., Vandereyken W., Guerrieri R., Vertommen H. (2006a) Impulsiveness and lack of inibitory cotrol in eating disorders. Eating Behaviors; 7: 196-203.
- French, S., et al. (1997) Ethnic differences in psychosocial and health behavior correlates of dieting, purging, and binge eating in a population-based sample of adolescent females; International Journal of Eating Disorders; 22: 315-322.
- Fowler, S.J., and Bulik, C.M. (1997) Family Environment and Psychiatric History in Women with Binge-eating Disorder and Obese Controls; Behaviour Change; 14: pag 106-112.
- Hodges E.L., Cochrane C.E., Brewerton T.D. (1998) Family characteristics of binge-eating disorder patients; International journal of eating disorders; march 1998; 23: 145-151.
- Loriedo C., Bianchi G., Perella C. (2002) Binge Eating Disorder: clinical, nosographic and therapeutic aspects; Italian Journal of Psychopathology; Mar. 8 (1).
- Monteleone P., Matias I., Martiadis V. (2005) Bood levels of the cannabinoid anandamide are increate in anorexia nervosa and binge eating disorder, but not in bulimia nervosa; Neuropsychipharmacology; 30: 1216-1221.
- Mussel M., Mitchell J., Weller C. (1995) Onset of Binge Eating, dieting, obesity, and mood disorder among subjects seeking treatment for Binge Eating Disorder. Int J. Eat Disord; 17:4:395-401.
- Spitzer, R.L., Devlin M., Walsh B.T., Hasin D., Wing R., Marcus M., Stunkard A., Wadden T., and Yanovski S. (1992) Binge eating disorder: A multisite field trial of the diagnostic criteria; International Journal of Eating Disorders; 11: 191-203. Spitzer R.L., Yanovski S., Wadden T., Wing R., Marcus M.D., Stunkard A., Devlin M., Mitchell J., Hasin D., and Horne R.L. (1993) Binge eating disorder: Its Further Validation in a Multisite Study; International Journal of Eating Disorders; 13: 137-153.
- Wolf E. M. and Crowther J. H. (1983) Personality and eating habit variables as predictors of severity of binge eating and weight. Addictive Behavior ; 8: 335-344.
- Womble L.G. et al. (2001) Psychosocial variables associated with binge eating in obese males and females; International Journal of Eating Disorders; 30:2: 217.
- Yanovski S.Z., Nelson J.E., Dubbert B.K., and Spitzer R.L. (1993) Association of binge eating disorder and psychiatric comorbidity in obese subjects; American Journal of Psychiatry; pag 150, pag 1472-1479.