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A primer on binge eating disorder diagnosis and management

Published online by Cambridge University Press:  18 December 2015

Leslie Citrome
Leslie Citrome*
Affiliation:
New York Medical College, Department of Psychiatry and Behavioral Sciences, Valhalla, New York, USA
*
*Address for correspondence: Leslie Citrome, MD, MPH, 11 Medical Park Drive, Suite 106, Pomona, NY 10970, USA.(Email: citrome@cnsconsultant.com)
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Abstract

Binge eating disorder (BED) is the most common eating disorder, with an estimated lifetime prevalence of 2.6% among U.S. adults, yet often goes unrecognized. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), BED is defined by recurrent episodes of binge eating (eating in a discrete period of time an amount of food larger than most people would eat in a similar amount of time under similar circumstances and a sense of lack of control over eating during the episode), occurring on average at least once a week for 3 months, and associated with marked distress. It can affect both men and women, regardless if they are at normal weight, overweight, or obese, and regardless of their ethnic or racial group. Psychiatric comorbidities are very common, with 79% of adults with BED also experiencing anxiety disorders, mood disorders, impulse control disorders, or substance use disorders; almost 50% of persons with BED have ≥3 psychiatric comorbidities. Multiple neurobiological explanations have been proffered for BED, including dysregulation in reward center and impulse control circuitry, with potentially related disturbances in dopamine neurotransmission and endogenous μ‐opioid signaling. Additionally, there is interplay between genetic influences and environmental stressors. Psychological treatments such as cognitive behavioral interventions have been recommended as first line and are supported by meta-analytic reviews. Unfortunately, routine medication treatments for anxiety and depression do not necessarily ameliorate the symptoms of BED; however, at present, there is one approved agent for the treatment of moderate to severe BED—lisdexamfetamine, a stimulant that was originally approved for the treatment of attention deficit hyperactivity disorder.

Keywords

binge eating disordercognitive-behavioral therapyinter-personal therapylisdexamfetamine
Type
CME Review Article
Information
CNS Spectrums , Volume 20 , Issue S1: CME SUPPLEMENT , December 2015 , pp. 41 - 51
Copyright
© Cambridge University Press 2015 

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Footnotes

This activity is supported by an unrestricted educational grant from Shire Pharmaceuticals Inc.

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