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Binge eating an abnormal eating pattern in which an individual eats significantly more food in a limited time than most people typically would eat. The time-frame for a binge is usually 1–2 hours.
The eating disorders anorexia nervosa and bulimia nervosa are considered psychiatric disorders and have formal diagnostic criteria that are define in the
(Illustration by GGS Information Services/Thomson Gale.)
Diagnostic and Statistical Manual for Mental Disorders Fourth Edition-Text Revision (DSM-IV-TR)published by the American Psychiatric Association (APA). Binge eating is an acknowledged problem, but it has not risen to the level a separate psychiatric disorder as defined by the APA. Some experts believe binge eating is a subtype of bulimia, an eating disorder characterized by episodes of binge eating followed by purging the body of calories. Other experts believe that binge eating should be classified as an obesity-related behavior. Some healthcare providers place binge-eating disorder in the APA category of eating disorders not otherwise specified. Although the way a healthcare professional views binge eating does not change the behavior, it may influence the type of therapy recommended and affect the degree to which treatment is covered by heath insurance providers.
Everyone eats too much occasionally, but people with binge-eaters disorder have an abnormal eating pattern that occurs frequently. Many eating disorder specialists define binge-eating disorder as binge eating behavior that occurs at least twice a week for three months and has a negative effect on the individual’s relationships and daily activities.
Binge eaters exhibit many of the following behaviors.
Estimates of the number of Americans who have binge-eating disorder range from less than 1% to 4%, with 2% being the most commonly cited figure. Although women with binge-eating disorder outnumber men 3:2, binge eating is the most common male eating disorder. The disorder affects blacks and whites equally; little research as been done on other racial or ethnic groups. Unlike the eating disorders anorexia nervosa or bulimia nervosa that start in the teenage or young adult years, binge eating disorder is more likely to occur in middle-aged adults between the ages of 46 and 55. Although binge eaters may be of normal weight, binge eating is a common disorder among people who are obese. Some estimates suggest that up to half the obese people in formal weight loss programs have problems with binge-eating.
People at higher risk of developing binge-eating disorder share certain characteristics. These include:
Binge eating is a relatively new area of research. Like all eating disorders, binge eating appears to have multiple causes. Some people seem to be genetically predisposed to become binge eaters. Researchers think this may be related to abnormalities in neurotransmitters in the brain that help to regulate appetite. Research continues actively in this area.
For many binge eaters, stress is the factor that triggers a binge. Stress can be caused by very restrictive dieting, but it is often caused by social and cultural factors, such as family conflict, job-related stress, dysfunctional relationships, and the repeated message from the media that a thin body is a sign of success, while being obese results in failure to find a mate or succeed in life.
Symptoms of binge eating may be difficult to detect. Binge eating is different from continuously snacking, and it is often done in private. Obesity and obesity-related diseases such as hypertension (high blood pressure) Type II diabetes, and joint pain are signs that binge-eating disorder could be present, but not all obese people are binge-eaters. Behaviors such as secretive eating, constant dieting without losing weight, obsessive concern about weight, depression, anxiety, and substance abuse are all clues, but none of these signs are definitive. The individual may complain about symptoms related to obesity, such as fatigue and shortness of breath, or mention unsuccessful dieting, but again, these signs are not definitive.
Binge eating can be hard for healthcare providers to diagnose. Binge eaters often go out of their way to hide how much they eat. They may, for example, buy snack food at the grocery store and eat it in the car before they go home, or they may buy food in secret and hoard it, so that people close to them will not know they are bingeing. Normally healthcare professionals begin diagnosis with a family and personal history. However, people with binge-eating disorder often lie about their eating habits.
A physician will begin with a physical examination and usually order standard laboratory tests such as a complete blood count (CBC), urinalysis, and blood tests to check the level of cholesterol, triglycerides, and electrolytes Additional tests, such as a thyroid function test, may be ordered to rule out other disorders. If the individual is obese, tests may be done check for obesity-related diseases such as diabetes, cardiovascular disease, and sleep apnea.
Several different evaluations can be used to examine a person’s mental state. A doctor or mental health professional will assess the individual’s thoughts and feelings about themselves, their body, their relationships with others, and their risk for self-harm.
People with binge-eating disorder understand that their eating pattern is abnormal and unhealthy. Nutrition counseling and meal planning can help bring weight under control, but they do not address the inability to control the impulse to binge. Nutrition counseling needs to be part of a broader treatment program that includes psychotherapy and possibly drug therapy.
Psychologists are more likely to approach the problem of binge eating by using therapy that helps the individual change his or her behavior and by treating emotional and psychological problems that cause it. For them, treating obesity is secondary to treating the behavior and the thought patterns that cause it. Psychologists tend to think that once the individual understands and can control bingeing behavior, obesity will be easier to treat.
Some types of psychotherapy that have been successful in treating people with binge-eating disorder are listed below.
There is no clear prognosis for binge eating disorder. Since stress often triggers bingeing, relapses are apt to occur in response to stressful life events. Some individuals find that simply seeking help improves their control over binge eating. For example, some studies have found that receiving a placebo is as effective as receiving medication. This is one reason why some parts of the medical community refuse to accept binge eating as a genuine disorder. Many studies are underway to test different approaches to treating binge eating. Individuals interested in participating in a clinical trial at no cost can find a list of studies currently enrolling volunteers at <http://www.clinicaltrials.gov>.
Since binge eating is difficult to detect, it is also difficult to prevent. Some prevention strategies are listed below
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National Eating Disorders Association. 603 Stewart Street, Suite 803, Seattle, WA 98101. Help and Referral Line: (800) 931-2237. Office Telephone: (206) 382-3587. Website: <http://www.edap.org>.
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Tish Davidson, A.M.