Treating the Most Common Eating Disorder

Bret S. Stetka, MD; Denise E. Wilfley, PhD

Disclosures

April 27, 2015

In This Article

Editor's Note: Binge eating disorder (BED) became a formal psychiatric diagnosis in 2013 with the release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). And in February of this year, the US Food and Drug Administration (FDA) approved the first medication to treat BED in adults. Medscape recently spoke with Denise E. Wilfley, PhD, eating disorder expert and professor of psychiatry at Washington University School of Medicine in St. Louis, Missouri, about the understanding, diagnosis, and management of this condition.

Medscape: BED is a relatively new diagnosis, first showing up in the DSM-5. What defines this condition?

Dr Wilfley: I have been studying the disorder for 20 years. BED was actually first documented in the 1950s, and it was acknowledged in the DSM-IV but as a provisional diagnosis, which helped generate more research. Due to sufficient research, BED became a formal diagnosis in the DSM-5. Ideally, BED will now be more readily diagnosed as providers become educated, and those who are suffering can become aware of the treatment options available.

BED is characterized by recurrent and persistent episodes of binge eating. A binge is characterized by eating, in a discrete period of time (eg, within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances, while experiencing loss of control over eating during the episode.

BED consists of such behaviors as eating much more rapidly than normal; eating until feeling uncomfortably full; eating large amounts of food when not physically hungry; eating alone due to embarrassment of how much one is eating; or feeling disgusted, depressed, or guilty after overeating. Individuals experience marked distress regarding their binge eating. To meet the formal diagnosis, an individual must binge an average of at least once per week for 3 months. BED differs from bulimia nervosa in that there is an absence of inappropriate compensatory behaviors associated with the overeating.

Medscape: How common is BED, particularly in relation to other eating disorders such as anorexia and bulimia?

Dr Wilfley: BED is the most common eating disorder, with about 3.5% of the population meeting the diagnostic criteria defined in the DSM-5. Only about 0.9% of the population meets criteria for anorexia nervosa and 1.5% of the population meets criteria for bulimia nervosa.

Medscape: Who is most commonly affected by BED?

Dr Wilfley: BED is two to four times more likely to occur in individuals who are overweight. BED is significantly associated with obesity, with up to 25% of those seeking obesity treatment meeting criteria for BED. Although it is common for individuals with BED to be overweight, not all individuals with BED are overweight and not all individuals who are overweight or obese engage in binge eating or meet criteria for BED. There are comparable rates of BED across racial and ethnic groups, but it is slightly more common in women than in men (a 3:2 ratio).

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