What is Binge Eating Disorder (BED)?
Binge Eating Disorder (BED) is a serious psychiatric disorder involving recurrent periods of binge-eating, as characterised by trance-like episodes of eating and consuming abnormally excessive amounts of food. Amongst all the eating disorders described in the Diagnostic and Statistical Manual of Mental Disorders (fifth edition), BED is the most commonly diagnosed, affecting around 2 to 3% of the population.
Although overeating may be considered normal from time-to-time, BED involves an excessive and recurring frequency of overeating, as well as other features like a deep sense of guilt or shame and feeling a lack of control over their behaviour during a binge-eating episode. For patients of BED, this can lead to serious physical health deterioration and high levels of psychological distress. Unlike other eating disorders, BED typically does not involve compensatory behaviours like purging or over-exercising.
What are the signs and symptoms of Binge Eating Disorder?
1. Binge Eating and Other Abnormal Eating Habits. Abnormal eating behaviours include eating more rapidly than normal, eating until uncomfortably full, eating large amounts of food even when not feeling hungry, eating alone due to feeling embrassed, and a feeling guilt or disgust with oneself after binge-eating.
2. Extreme Scrutiny Over Body Weight, Shape and Image. Patients of BED typically have a very low self-esteem and are highly insecure of their own body. This can manifest in behaviours like constantly looking at their reflection in the mirror and can further drive binge-eating habits.
3. Fear of Eating Around Others or In Public. BED patients tend to be afraid of others judging the amount of food they are consuming. This results in behaviours like secretly hiding or hoarding food in odd places and eating alone.
4. Feeling a Lack of Control. People with BED tend to feel like they are unable to stop eating due to this lack of control with their own behaviour. This further spirals into extreme negative emotions regarding their inability to stop their binging.
5. Feeling a Sense of Disgust, Shame or Guilt For Oneself. Stemming from feeling a lack of control over their own behaviour, patients will typically have binge-eating episodes in secret and then feel ashamed, guilty or embarrassed either during the episode or after.
6. Social Withdrawal. Rooted in their fear of eating in public or in front of others, as well as the sense of shame anf disgust for themelves, BED patients tend to withdraw socially and distance themselves from their family and friends.
7. Frequent Dieting. A common sign that someone could be struggling with BED is the act of abusing dietary regimens. This behaviour manifests in frequent and excessive dieting, which typically involves drastic dieting habits like fasting or completely cutting out major food groups all at once (e.g., no sugar, carbs, dairy, etc.).
8. Difficulties in Concentrating. Someone with BED may be too occupied with the overwhelming thoughts of a negative self-image, body weight and shape, and binging. This results in the inability to focus and contentrate well, and vice versa: poor concentration and boredom, when attending to tedious tasks, lead to exessive eating and bingeing on food.
9. Gastrointestinal Issues. The unhealthy nature of binge-eating behaviour can be harmful towards the gastrointestinal system, leading to symptoms like stomach cramping, acid reflux, constipation, etc.
10. Fluctuation in Weight. While weight gain and obesity is commonly associated with BED, patients with BED can also drastically lose weight and become malnourished. Fluctuations in weight, both ways, is a classic sign of BED.
How to Diagnose Binge Eating Disorder?
Binge Eating Disorder (BED) is typically diagnosed through a comprehensive evaluation by a licensed medical and/or mental health professional, based on the diagnostic guidelines provided by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).
Diagnostic Criteria for BED
The DSM-V states that a diagnosis of BED would require that patient has recurrent binge-eating episodes involving eating excessive amounts of food that is abnormal for the average person within a discrete a period of time. These binge-eating episodes must occur at least one day a week, and have been occuring for at least a duration of 3 months.
The binge-eating episodes must also be associated with at least three of the following:
- Eating more rapidly than normal
- Eating until uncomfortably full
- Eating large amounts of food, even when not feeling hungry
- Eating alone due to embarassment of how much food they are eating
- Feeling depressed, guilty or disgusted with oneself after overeating
Furthermore, the patient must not regularly perform any compensatory behaviours like purging (i.e, self-induced vomiting), inappropriate fasting or excessively exercising.
Severity Levels of Binge Eating Disorder
According to the DSM-V, there are four levels of severity of BED, depending on the frequency of binge-eating episodes.
- Mild: 1 to 3 episodes per week
- Moderate: 4 to 7 episodes per week
- Severe: 8 to 13 episodes per week
- Extreme: 14 or more episodes per week
Who Can Diagnose Binge Eating Disorder?
BED can be diagnosed by licensed healthcare providers like your family doctor (general practitioner or paediatrician), or mental health professionals like psychiatrists and psychologists. For BED, the diagnostic process is similar across various countries like Australia, United Kingdom and United States.
General Practitioner or Pediatrician
Typically, a GP can directly diagnose BED through evaluating a patient’s symptoms, physical health, lifestyle and mental health. A GP would typically ask questions surrounding the patient’s medical background, their eating habits and how they are feeling at the time. Alongside this, a GP can also ask the patient to complete a physical examination, blood work, urine tests and also some questionnaires, e.g., EDE-Q (for adults) or EDE-A (for adolescents), for a more refine diagnosis and for better understanding of the patient’s circumstance.
Psychiatrist and Psychologist
Psychiatrists and psychologists can also diagnose BED, with the referral from a GP. Patients who are referred to specialists like psychiatrists and psychologists are typically more complex cases of BED that require more specific psychiatric care.
Similar to GPs, specialists typically ask their patients questions on their lifestyle, eating habits, physical and mental health. Additionally, psychiatrists and psychologists focus more on the psychological aspects of BED. This means that they would ask questions surrounding the patient’s mental health as part of a psychological evaluation, which assesses a patient’s mental state and addresses the psychological symptoms of BED (i.e., lack of control, self-disgust, depression, etc.)
Diagnosis and Treatment Process of BED
How to Get Tested for Binge Eating Disorder?
There is no single test which directly tests for BED. Rather, providers will diagnose BED through an evaluation of the symptoms present according to the DSM-V guidelines, and also considering factors like their life background, physical health, mental health and lifestyle.
A typical approach towards getting a diagnosis for BED involves making a visit to your GP and voicing your concerns if you think you are experiencing any symptoms of BED. From there, your GP would ask questions regarding the presenting symptoms, medical history (personal and family) and eating patterns. Your GP will conduct a physical examination, which can include measuring body weight, checking blood pressure and heart rate, and completing lab tests like blood test, urine test and electrocardiogram test (ECG) to assess overall health. Upon diagnosis, your GP may also refer you to a specialist like a psychiatrist or psychologist for further psychological evaluation and care.
During the diagnostic process for BED, it is also likely that you are asked to complete a self-report questionnare on BED. A common questionnaire used by providers is the Binge-Eating Disorder Screener-7 (BEDS-7), which is an assessment screening tool used to identify potential patients of BED, based on the symptoms outlined by the DSM-V. A more detaled test is called Eating Disorder Examination Questionnaire (EDE-Q), this test allows access to greater range oftreatment resources, e.g., in Australia – to a higher number of therapy hours funded by Medicare.
How to Treat Binge Eating Disorder?
There are various methods of treatment for BED, such as psychological treatment and pharmological treatment (i.e., medication).
A popular psychological treatment used to treat BED is Cognitive Behavioural Therapy (CBT) which involves the reconstruction of a person’s cognitive beliefs, particularly negative or maladaptive thoughts that may lead to anxiety or distress. For BED, this would involve reconstructing negative beliefs regarding binging behaviour (i.e., negative self-esteem and feelings of shame or disgust towards the self). CBT involves active participation from the patient, as the mental health professional guides them through tasks like identifying negative beliefs, setting goals and establishing coping strategies. CBT can be administered by a licensed mental health professional like a therapist or psychologist.
Medication, although less popular, is also used to treat BED. Lisdexamfetamine, also commercially known as Vyvanse, is supported by evidence in being an effective and safe method of treatment for moderate to severe BED. Common side effects include nausea, dizziness, dry mouth and irritability. Methylphenidate and topiramate are often used too, to suppress or regulate person’s appetite.
An additional treatment method for BED is nutritional counselling (practically overlapping with behavioural therapy, part of CBT) with a registered dietition or nutritionist. Nutritional counselling involves development of practical skills around meal plannign and preparation, cooking routines and following through a recipe (all of whcih are often a major problem), as well as specialised dietary techniques used to maintain regular nutritional intake and foster a healthy relationship with food. With the guidance of a dietition, BED patients are able to create a healthy and easy meal plan that is specifically tailored to their needs and effectively reduces their binging urges.
Research evidence has shown that a combination of both psychological treatments and medication is the most effective method of treatment (e.g., CBT and Medication). With the adequate treatment and support, patients of BED are able to successfully recover from BED and go into remission.
With any disorder, recognising the symptoms and seeking help is the first step towards treatment and recovery. Thus, it is important to know the symptoms involved, as well as the important steps to take in seeking a diagnosis and treatment. Binge Eating Disorder can be diagnosed by a general practitioner or a specialist like a psychologist or psychiatrist. If experiencing any known symptoms, patients should consult their GP and express their concerns, seeking practical support from designated clinicians.
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