Binge Eating Disorder (BED)
Definition | Aetiology | Pathophysiology | Risk factors | Signs and symptoms | Investigations | Management
Definition
Binge Eating Disorder (BED) is a mental health condition characterised by recurrent episodes of excessive food consumption within a short period, accompanied by a sense of loss of control, without compensatory behaviours such as purging or excessive exercise.
Aetiology
- Genetic factors: familial predisposition to eating disorders.
- Neurobiological factors: dysregulation of dopamine and serotonin pathways.
- Psychosocial factors: history of dieting, low self-esteem, or emotional distress.
- Environmental influences: exposure to weight stigma or societal pressure regarding body image.
Pathophysiology
- Impaired satiety regulation due to altered serotonin activity.
- Increased reward-seeking behaviour associated with dopamine dysfunction.
- Hypothalamic-pituitary-adrenal (HPA) axis dysregulation affecting stress response and appetite control.
Risk factors
- Family history of eating disorders or obesity.
- History of restrictive dieting or weight cycling.
- Psychiatric comorbidities (e.g., depression, anxiety, substance misuse).
- Emotional distress or trauma.
- Childhood obesity or early exposure to disordered eating behaviours.
Signs and symptoms
- Recurrent episodes of binge eating, often secretive.
- Loss of control over eating during binge episodes.
- Eating large quantities of food rapidly, even when not hungry.
- Marked distress regarding binge eating behaviours.
- Feelings of guilt, shame, or disgust after eating.
- Physical consequences such as weight gain, metabolic syndrome, and gastrointestinal discomfort.
Investigations
- Clinical assessment: comprehensive eating history, including triggers and emotional associations with eating.
- Screening tools: Binge Eating Scale (BES), Eating Disorder Examination Questionnaire (EDE-Q).
- Blood tests: FBC, U&Es, LFTs, lipid profile, HbA1c to assess metabolic impact.
- Body mass index (BMI): to evaluate weight-related health risks.
Management
1. Psychological therapies:
- Cognitive Behavioural Therapy for Eating Disorders (CBT-E) as first-line treatment.
- Interpersonal therapy (IPT) to address emotional triggers.
- Mindfulness-based interventions to improve awareness and reduce impulsive eating.
2. Pharmacological management:
- First-line: Selective serotonin reuptake inhibitors (SSRIs) (e.g., fluoxetine) to reduce binge episodes.
- Second-line: Lisdexamfetamine or topiramate for severe or treatment-resistant cases.
3. Lifestyle modifications:
- Regular meal patterns to reduce binge triggers.
- Physical activity to improve mood and overall well-being.
- Addressing emotional eating with structured coping strategies.
4. Referral:
- Eating disorder services: for structured therapeutic intervention.
- Dietitian: for nutritional counselling and weight management.
- Psychiatrist: for pharmacological treatment in severe cases.