Binge Eating Disorder (BED)

Definition | Classification (ICD-10 and DSM-5) | Aetiology | Risk Factors | Clinical Presentation | Investigations | Management | When to Refer | References

Definition

Binge Eating Disorder (BED) is a serious mental health condition characterised by recurrent episodes of eating large quantities of food, often rapidly and to the point of discomfort. These episodes are accompanied by a sense of loss of control and significant distress. Unlike bulimia nervosa, BED does not involve regular compensatory behaviours such as vomiting, excessive exercise, or fasting.

Classification (ICD-10 and DSM-5)

Binge Eating Disorder is classified under the following diagnostic criteria:

ICD-10 Classification

In the ICD-10, Binge Eating Disorder is classified under:

• F50.9 - Eating Disorder, Unspecified: While BED is not specifically listed in the ICD-10, it can be coded under this broader category. The ICD-11, however, includes BED as a distinct diagnosis.

DSM-5 Classification

In the DSM-5, Binge Eating Disorder is classified under:

• 307.51 (F50.81) - Binge Eating Disorder: This diagnosis requires recurrent episodes of binge eating, occurring at least once a week for three months. The episodes must be associated with three (or more) of the following: eating more rapidly than normal, eating until uncomfortably full, eating large amounts of food when not physically hungry, eating alone due to embarrassment, and feeling disgusted, depressed, or guilty after overeating.

Aetiology

The exact cause of Binge Eating Disorder is not fully understood, but it is believed to result from a combination of genetic, psychological, and environmental factors:

• Genetic Factors: A family history of eating disorders, obesity, or other mental health conditions may increase the risk of developing BED, suggesting a genetic predisposition.
• Psychological Factors: BED is often associated with low self-esteem, body dissatisfaction, and emotional distress. Individuals may use binge eating as a coping mechanism for dealing with negative emotions or stress.
• Environmental Factors: Cultural pressures to be thin, exposure to dieting, and societal stigmas around weight and body image may contribute to the development of BED.
• Neurobiological Factors: Dysregulation of brain chemicals involved in hunger, satiety, and mood regulation, such as serotonin and dopamine, may play a role in BED.

Risk Factors

Several factors increase the likelihood of developing Binge Eating Disorder:

• Family History: A family history of eating disorders, depression, or substance abuse increases the risk of developing BED.
• Psychological Issues: Individuals with a history of depression, anxiety, or other mood disorders are more likely to develop BED.
• Dieting History: A history of frequent dieting or a pattern of restrictive eating followed by periods of overeating can lead to the development of BED.
• Stressful Life Events: Traumatic or stressful life events, such as abuse, significant loss, or ongoing stress, may trigger or exacerbate binge eating behaviours.
• Body Image Issues: Individuals with poor body image or dissatisfaction with their appearance are at higher risk for BED.

Clinical Presentation

Binge Eating Disorder presents with a range of psychological and behavioural symptoms:

Binge Eating Episodes

• Eating Large Quantities of Food: Consuming an amount of food that is definitely larger than most people would eat in a similar period under similar circumstances.
• Sense of Loss of Control: Feeling unable to stop eating or control how much one is eating during a binge episode.
• Rapid Eating: Eating much more quickly than usual, often in a hurried or frantic manner.
• Eating When Not Hungry: Consuming food even when not physically hungry, often to cope with emotional distress.
• Eating Alone: Avoiding eating with others due to embarrassment about the quantity of food being consumed.
• Negative Feelings After Eating: Experiencing feelings of disgust, guilt, or depression after overeating.

Physical and Emotional Consequences

• Weight Gain: BED often leads to significant weight gain, which may result in obesity and related health problems such as type 2 diabetes, hypertension, and cardiovascular disease.
• Emotional Distress: Individuals with BED often experience high levels of psychological distress, including depression, anxiety, and low self-esteem.
• Gastrointestinal Issues: Frequent binge eating can cause gastrointestinal problems, such as bloating, constipation, and abdominal pain.

Investigations

The diagnosis of Binge Eating Disorder is primarily clinical, based on a detailed history and assessment of symptoms. Additional investigations may include:

• Psychiatric Assessment: A comprehensive mental health evaluation to assess the frequency, severity, and impact of binge eating episodes, as well as the presence of co-occurring mental health conditions such as depression or anxiety.
• Physical Examination: A physical examination to assess the patient’s overall health, including weight, BMI, and any obesity-related complications.
• Laboratory Tests: Blood tests to evaluate for metabolic complications of obesity, such as dyslipidaemia, impaired glucose tolerance, or liver function abnormalities.
• Screening Tools: The use of validated questionnaires, such as the Binge Eating Scale (BES) or the Eating Disorder Examination Questionnaire (EDE-Q), to quantify the severity of binge eating behaviour.

Management

The management of Binge Eating Disorder typically involves a combination of psychological therapies, pharmacotherapy, and lifestyle interventions:

Psychological Therapies

• Cognitive Behavioural Therapy (CBT): The most effective psychological treatment for BED, focusing on changing distorted thoughts and behaviours related to eating, body image, and weight. CBT helps individuals develop healthier eating patterns and coping mechanisms for managing emotional distress.
• Interpersonal Therapy (IPT): Addresses interpersonal issues that may contribute to the development or maintenance of BED, such as relationship difficulties, social isolation, or unresolved grief.
• Dialectical Behaviour Therapy (DBT): May be used to help individuals with emotional regulation and reduce impulsive behaviours such as binge eating.
• Mindfulness-Based Therapies: Focuses on developing mindfulness skills to help individuals become more aware of their eating behaviours and reduce the tendency to binge eat in response to emotional triggers.

Pharmacotherapy

• Antidepressants: Selective Serotonin Reuptake Inhibitors (SSRIs), such as fluoxetine, have been shown to reduce binge eating episodes and improve mood in individuals with BED.
• Anti-Obesity Medications: Lisdexamfetamine, a medication used for attention-deficit hyperactivity disorder (ADHD), has been approved for the treatment of BED and can help reduce binge eating frequency.
• Other Medications: Antiepileptic medications such as topiramate may also be used off-label to reduce binge eating episodes and promote weight loss.

Lifestyle Interventions

• Nutritional Counselling: Working with a dietitian to develop a balanced, healthy eating plan that addresses the individual’s nutritional needs and helps prevent binge eating episodes.
• Regular Physical Activity: Encouraging regular exercise to improve physical health, support weight management, and reduce stress.
• Behavioural Weight Management Programmes: Structured programmes that combine dietary changes, physical activity, and behavioural strategies to promote long-term weight loss and improve overall health.

When to Refer

Referral to a specialist eating disorder service or psychiatrist may be necessary in the following situations:

• Severe or treatment-resistant BED that does not respond to initial therapies, requiring more intensive or specialised interventions.
• Presence of co-occurring mental health conditions, such as severe depression, anxiety, or substance abuse, that require integrated treatment.
• Significant medical complications related to obesity, such as type 2 diabetes, cardiovascular disease, or obstructive sleep apnoea, that require multidisciplinary management.
• Need for specialised psychological therapies, such as CBT or DBT, that are not available in primary care settings.

References

1. National Institute for Health and Care Excellence (2024) Eating Disorders: Recognition and Treatment. Available at: https://www.nice.org.uk/guidance/ng69 (Accessed: 26 August 2024).
2. American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Available at: https://www.psychiatry.org/psychiatrists/practice/dsm (Accessed: 26 August 2024).
3. World Health Organization (1992) ICD-10 Classification of Mental and Behavioural Disorders. Available at: https://www.who.int/classifications/icd/en/bluebook.pdf (Accessed: 26 August 2024).

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