Binge Eating Disorder: Progress and Prospects

In 1959, Albert Stunkard noted three distinct patterns of eating behavior among obese patients: night eating, binge eating, and eating without satiation. Since that time, research on binge eating has proliferated. Operational criteria have been developed in order to facilitate its assessment in both obese and non-obese individuals. Investigations by Spitzer and colleagues (Spitzer et al, 1992, 1993) led to the inclusion of binge eating disorder (BED) in the DSM-IV as a proposed diagnostic category for further study and as an example of an eating disorder not otherwise specified (EDNOS).

BED is characterized by persistent and recurrent episodes of binge eating in the absence of regular inappropriate compensatory behavior such as vomiting. Related features of the disorder include eating until uncomfortably full, eating when not physically hungry, eating alone because of embarrassment, and feelings of disgust, depression or guilt, after overeating. BED tends to have a chronic and fluctuating course, and is associated with increased psychopathology including depression, anxiety, and personality disorders.

Most seek treatment for overweight. Although BED is not limited to obese individuals, it is most common in this group. In fact, the majority of people with this disorder who seek help do so for treatment of overweight rather than for binge eating. About one-third of individuals seeking university-based behavioral weight control treatment binge eat. In community samples, the prevalence of BED has been found to be 1% to 2%. Moreover, recent research suggests that, in contrast to the other eating disorders, which are more prevalent among whites, BED is as common among black and Hispanic women as in white women.

CBT Is Front-line Treatment

Eating disorder treatments tailored specifically to BED, such as cognitive behavior therapy (CBT) and interpersonal psychotherapy (IPT), improve binge eating, but have little effect on weight. CBT has been the best-studied approach and is currently considered the front-line treatment. Self-help approaches based on cognitive behavioral techniques, such as Overcoming Binge Eating (Fairburn, 1995) may be useful for some patients. It is important to note that standard weight loss treatments such as behavior therapy and bariatric surgery do not exacerbate binge eating problems, but are associated with short-term reductions in binge eating and improvements in mood. Thus, both eating disorder and obesity treatments appear to be beneficial in BED.

Drug treatment. Data on pharmacological treatment of BED are limited. Antidepressants may be effective, though less so than psychotherapy. Results are pending from studies investigating the combination of medication and psychotherapy.

BED as a Separate Diagnosis

Available research suggests that there is a group of individuals with impairment or distress linked to the disorder, and numerous studies have detailed the associated features of this syndrome. However, as “We study what we define” (Walsh & Kahn, 1997), it seems advisable for researchers to study the full range of clinically significant overeating. Further investigations comparing obese and non-obese patients with and without BED are needed. Such research may help clarify the distinctions between BED and bulimia nervosa, non-purging type. Prospective studies are needed to clarify the direction of associations among binge eating, weight, and mood in the general population, including men and ethnic minorities. Finally, family history and twin studies will be invaluable in determining the heritability of the disorder.

The Future

With respect to treatment of BED in the next millennium, more emphasis should be placed on disseminating effective approaches such as CBT and IPT, which are not widely available. There is also a need to develop algorithms for matching patients to treatments. Further study of treatment non-responders is also warranted in order to improve outcome and long-term maintenance.