Definition and Diagnosis
Binge-eating disorder is characterized by recurrent episodes of eating, within a discrete period, an amount of food that is definitely larger than most people would eat under similar circumstances, accompanied by a sense of lack of control, and without the regular use of compensatory behaviors seen in bulimia nervosa.
Epidemiology
Binge-eating disorder is the most common eating disorder, with lifetime prevalence estimated around 2-3.5% in women and somewhat lower in men, and it is often associated with overweight or obesity, though it occurs across the weight spectrum.
Risk Factors
Risk factors include a history of dieting, body image dissatisfaction, family history of eating or mood disorders, impulsivity, and a history of weight-based teasing or trauma.
Symptoms and Subtypes
Binge episodes are typically associated with eating much more rapidly than normal, eating until uncomfortably full, eating large amounts when not physically hungry, eating alone due to embarrassment, and subsequent feelings of guilt or disgust, occurring at least once a week for three months.
Diagnosis
DSM-5-TR criteria require recurrent binge-eating episodes with marked distress, occurring on average at least once a week for three months, and not associated with the regular compensatory behaviors that would indicate bulimia nervosa.
Treatment
Cognitive behavioral therapy is first-line and highly effective; interpersonal therapy and structured self-help are also supported. Lisdexamfetamine is FDA-approved for moderate-to-severe binge-eating disorder, and SSRIs may reduce binge frequency.
Prognosis
Binge-eating disorder generally has a more favorable prognosis than anorexia or bulimia nervosa, with many individuals achieving significant reduction in binge frequency with treatment, though weight-related medical monitoring may still be needed.
Reference
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).