Understanding Binge-Eating Disorder

When you hear the words “eating disorder,” what’s the first thing that comes to mind?

Most likely, you think of anorexia nervosa or bulimia nervosa, conditions often marked by extreme low weight (anorexia) and binge eating and purging (bulimia).

But the most common eating disorder is binge-eating disorder, which affects an estimated 2.8 million people in the United States. That’s more than three times the number of people diagnosed with anorexia and bulimia combined.

“Historically, binge-eating disorder hasn’t gotten nearly as much attention as anorexia nervosa or bulimia nervosa, and it still doesn’t get the attention it deserves,” says Cynthia Bulik, PhD, founding director of the Center of Excellence for Eating Disorders at the UNC School of Medicine.

“One reason is that binge-eating disorder wasn’t even recognized as a formal diagnosis until a few years ago, when for the first time it was included in the DSM-5,” Bulik says. (DSM-5 is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, which the American Psychiatric Association published in 2013.)

Defining Binge-Eating Disorder

Binge-eating disorder is characterized by several behavioral and emotional signs or symptoms. These may include recurrent episodes of binge eating, eating a larger amount of food than normal during a two-hour period, and a feeling that you can’t control what or how much you are eating during a binge episode.

In addition, people with binge-eating disorder often say they feel disgusted, depressed, ashamed or guilty after a binge episode. As a result, they may eat alone so others won’t see how much they eat. They may also eat until they feel uncomfortably full, eat large amounts of food even when they don’t feel hungry or eat much faster than normal.

People with binge-eating disorder do not regularly use compensatory behaviors that are common in bulimia nervosa, such as purging (self-induced vomiting) or excessive exercise.

Treatment of Binge-Eating Disorder

Binge-eating disorder is most commonly treated in an outpatient setting, but some people may require hospitalization or a residential treatment program.

Treatment services for binge-eating disorder are likely to vary by person but typically include psychotherapy (including individual, family or couples, or group therapy), family member support or education, specialized nutrition counseling and medication therapy.

Bulik and other researchers conducted a systematic review and meta-analysis of treatment options for binge-eating disorder that was published in the Annals of Internal Medicine in 2016.

Their review concluded that several courses of treatment helped reduce binge eating and the negative feelings that people often experience because of it: cognitive behavioral therapy; lisdexamfetamine (Vyvanse, the first drug approved by the Food and Drug Administration for treating binge-eating disorder in adults); antidepressants such as fluoxetine (Prozac), bupropion (Wellbutrin), sertraline (Zoloft), escitalopram (Lexapro) and citalopram (Celexa); and the anti-seizure drug topiramate (Topamax).

In addition, the review found that lisdexamfetamine and topiramate helped reduce weight in adults with binge-eating disorder.

A New Study for Binge-Eating Disorder

Bulik is leading a new study, the Binge Eating Genetics INitiative (BEGIN), to better understand genetic factors that may be associated with binge-eating disorder and bulimia nervosa in order to develop better treatments for the millions of people who suffer from these illnesses.

The study will enroll 1,000 participants via the Recovery Record app, the leading technology platform for eating disorder management. Participants will receive intervention through the app on Apple Watch and iPhone while contributing information about thoughts, emotions and behaviors associated with binge eating. Participants will also contribute heart rate and activity data from Apple Watches, saliva for DNA genotyping and stool samples for microbiota sequencing.

Enrollment is open to people ages 18 to 45 living in the United States. To see if you might be eligible to participate, go to beginstudy.org to complete a brief screening questionnaire.

Need help for binge-eating disorder for yourself or a loved one? Contact the UNC Center of Excellence for Eating Disorders at 984-974-3834.