Download Let`s Talk About Binge Eating Disorder

Let's Talk About Binge Eating
Disorder
Binge-eating disorder (BED) can be challenging to identify. Its prevalence in the general
population is about 2%,[1] and according to the newly released 5th edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM-5), BED has a distinct clinical profile from bulimia
nervosa, which is also characterized by recurrent episodes of binge eating, and anorexia
nervosa. Unlike these eating disorders, patients with BED do not exhibit inappropriate
compensatory behaviors, such as purging, fasting, or excessive exercise (Table 1).[2] As a
result, many individuals with BED are overweight or obese, as they do not purge after binge
eating. However, many clinicians overlook a possible diagnosis of BED among their nonobese
patients.
Table 1. DSM-5 Diagnostic Criteria
Binge eating
No compensatory behavior
Indicators of loss of control
Marked distress
One binge/week for 3 months
Accurate and timely diagnosis is critical, because BED is associated with a number of serious
medical comorbidities, such as obesity and Type 2 diabetes and metabolic syndrome (elevated
triglycerides, abdominal obesity, hypertension, low HDL),[3-5] as well as mood and anxiety
disorders.[3.6]
Screening for BED
Simple questions about eating behavior and attitudes can often uncover eating disorders.
Effective questions include:
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Do you have any concerns about your eating behavior or your relationship with food?
Have you ever felt like your eating was out of control?
Do you have eating binges during which you eat an unusually large amount of food
for the situation yet cannot stop eating?
Have you ever felt disgusted with your eating? A “no” answer to this question has a
high negative predictive value, which makes it an effective screening question for
BED.
In addition, commonly used instruments for screening for an eating disorder include the Eating
disorder Screen for Primary care (ESP) and the SCOFF questionnaire (Table 2).
Let's Talk About Binge Eating
Disorder
Ask Your Patients
Individuals with binge-eating disorder can be elusive, but these direct questions, used in the
context of a trusting therapeutic relationship by the primary care provider, can help you to help
these patients.
Table 2. Screening for Eating Disorder
ESP
SCOFF
Are you satisfied with your eating patterns?
Do you make yourself Sick because you feel
uncomfortably full?
Do you ever eat in secret?
Do you worry you have lost Control over how
much you eat?
Does your weight affect the way you feel
about yourself?
Have you recently lost more than One stone
(14 lb) in a 3-month period?
Have any members of your family suffered
with an eating disorder?
Do you believe yourself to be Fat when others
say you are thin?
Do you currently suffer with or have you ever
suffered in the past with an eating disorder?
Would you say that Food dominates your life?
A positive result from questioning should be followed up with a full eating disorder diagnostic
interview. Such tools include the Structured Clinical Interview for DSM-IV (SCID-IV),[7] and the
Eating Disorder Examination (EDE)[8] interview or the EDE questionnaire.[9] The severity of
binge eating behavior can be assessed with the Binge Eating Scale.[10]
References
1.
Smink FR1, van Hoeken D, Hoek HW. Epidemiology, course, and outcome of eating disorders. Curr Opin
Psychiatry. 2013;26:543-548.
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
(DSM-5), American Psychiatric Association, Arlington, VA 2013.
3. Hudson JI, Lalonde JK, Coit CE, et al. Longitudinal study of the diagnosis of components of the metabolic
syndrome in individuals with binge-eating disorder. Am J Clin Nutr. 2010;91:1568-1571.
4. Crow S, Kendall D, Praus B, Thuras P. Binge eating and other psychopathology in patients with type II
diabetes mellitus. Int J Eat Disord. 2001;30:222-226.
5. Barnes RD1, Boeka AG, McKenzie KC, et al. Prim Care Companion CNS Disord. 2011;13.
6. Kessler RC, Berglund PA, Chiu WT, et al. The prevalence and correlates of binge eating disorder in the
World Health Organization World Mental Health Surveys. Biol Psychiatry. 2013;73:904-914.
7. First MB, Spitzer RL, Gibbon M, et al. Structured Clinical Interview for DSM-IV Axis I Disorders-Patient
Edition (SCID I/P. Version 2.0). New York: Biometric Research, New York State Psychiatric Institute; 1995.
8. Fairburn CG, Cooper Z. The eating disorder examination. In: Fairburn C, Wilson GT, editors. Binge eating:
nature, assessment and treatment. 12th ed. New York: Guilford Press; 1993. pp. 317-360.
9. Fairburn CG, Beglin SJ. Assessment of eating disorders: Interview or self-report questionnaire? Int J Eat
Disord. 1994;16:363-370.
10. Gormally J, Black S, Duston S, et al. The assessment of binge eating severity among obese persons.
Addict Behav. 1982;7:47-55.