Binge Eating Disorder
Disclaimer:
For exam purposes, the priority is to recognise binge eating disorder and distinguish it from anorexia nervosa and bulimia nervosa. This article therefore focuses on clinical features, DSM-5 diagnosis, and key management.
High-Yield Comparison Between Eating Disorders
| Feature | Anorexia nervosa | Bulimia nervosa | Binge-eating disorder |
|---|---|---|---|
| Body weight | Significantly low body weight | Usually normal | No diagnostic weight requirement |
| Restricted intake | Core feature | May occur between binges as compensation | Not a core requirement |
| Binge eating | May occur in binge-eating/purging subtype | Required | Required |
| Compensatory behaviours (e.g. self-induced vomiting, excessive exercise) | May occur | Required | Absent |
| Weight gain / body-image concerns | Core feature (fear of weight gain + body image / weight disturbance) | Core feature (body image / weight disturbance) (fear of weight gain is NOT a core feature) | Not required |
| One-liner exam discriminator | Significantly low body weight + energy restriction (e.g. fasting) + fear of weight gain / body-image disturbance +/- binge eating or purging | Relatively normal body weight + binge eating + compensatory behaviours (e.g. excessive exercise, purging) + body-image disturbance | Recurrent binge eating without compensatory behaviours |
Clinical Features and Diagnosis
DSM-5 criteria for binge eating disorder (ALL must be met): [Ref]
- Recurrent binge eating episodes, characterised by both
- Eating an excessively large amount of food within any 2-hour period (specifically defined as an amount of food that is definitively larger than what most individuals would eat in a similar period of time under similar circumstances)
- Feeling of not being able to stop eating, or control what or how much is eaten
- Binge eating episodes are associated with at least 3 of the following
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not feeling physically hungry
- Eating alone because of being embarrassed by how much one is eating
- Feeling disgusted with oneself, depressed, or very guilty after overeating
- Presence of marked distress regarding binge eating
- Binge eating occurs at least once a week for 3 months (on average)
- NO regular compensatory behaviours (e.g. purging, fasting, excessive exercise) and does NOT occur exclusively during the course of anorexia nervosa or bulimia nervosa
Unlike bulimia nervosa, binge eating disorder is NOT associated with regular compensatory behaviours and body weight is not part of the diagnostic criteria.
Management
The mainstay of management is psychological therapy for binge eating disorder
The choice of psychological therapy is the same for both adults and paediatric patients:
- 1st line: binge-eating-disorder-focused guided self-help programme
- 2nd line: eating-disorder-focused group CBT
- 3rd line: eating-disorder-focused individual CBT
Do NOT offer medication as the sole treatment for binge eating disorder.