Binge eating in overweight women

The classification of bulimic eating disorders: a community-based cluster analysis study

There is controversy over how best to classify eating disorders in which there is recurrent binge eating. Many patients with recurrent binge eating do not meet diagnostic criteria for other of the two established eating disorders, anorexia nervosa or bulimia nervosa. The present study was designed to derive an empirically based, and clinically meaningful, diagnostic scheme by identifying subgroups from among those with recurrent binge eating, testing the validity of these subgroups and comparing their predictive validity with that of the DSM-IV scheme. A general population sample of 250 young women with recurrent binge eating was recruited using a two-stage design. Four subgroups among the sample were identified using a Ward's cluster analysis. The first subgroup had either objective or subjective bulimic episodes and vomiting or laxative misuse; the second had objective bulimic episodes and low levels of vomiting or laxative misuse; the third had subjective bulimic episodes and low levels of vomiting or laxative misuse; and the fourth was heterogeneous in character. This cluster solution was robust to replication. It had good descriptive and predictive validity and partial construct validity. The results support the concept of bulimia nervosa and its division into purging and non-purging subtypes. They also suggest a possible new binge eating syndrome. Binge eating disorder, listed as an example of Eating Disorder Not Otherwise Specified within DSM-IV, did not emerge from the cluster analysis.

Comorbidity and binge eating disorder

Research in obesity has generally not demonstrated an association with increased rates of psychopathology compared to normal-weight comparison groups. However, studies of obese individuals from clinical samples with recurrent binge eating or binge eating disorder (BED) have generally revealed increased rates of psychiatric comorbidity compared to non-binge eating obese individuals. Also, several studies have reported finding an association between BED and elevated rates of psychological distress, social problems, and impaired self-esteem. This report provides an overview of research findings regarding psychiatric comorbidity among individuals with BED, and it presents suggestion for future research.

Pharmacotherapy of bulimia nervosa and binge eating disorder

This paper reviews the use of medication in the treatment of bulimia nervosa and of binge eating disorder. There is now compelling evidence from double blind, placebo-controlled studies that antidepressant medication is useful in the treatment of bulimia nervosa. What is less clear is which patients are most likely to benefit from antidepressant medications and how to best sequence the various therapeutic interventions available. The utility of antidepressant medications in bulimia nervosa has led to their evaluation in binge eating disorder. The limited information currently available suggests that antidepressant treatment may be associated with a reduction in binge frequency in obese patients with binge eating disorder, but does not lead to weight reduction. Additional studies of the use of medication in the treatment of binge eating disorder and of the role of pharmacotherapy in the treatment of bulimia nervosa are needed.

General population-based epidemiological study of eating disorders in Norway

In a questionnaire-based study of eating disorders in a representative sample of the general female population of Norway, the lifetime prevalence of eating disorders was 8.7% with a point prevalence of 3.8%. The lifetime prevalence of binge eating disorder (BED) was 3.2%, bulimia nervosa (BN) 1.6%, and anorexia nervosa (AN) 0.4%. Eating disorders not otherwise specified (EDNOS) had a lifetime prevalence of 3.0%. Point prevalence of BED was 1.5%, BN 0.7%, AN 0.3%, and EDNOS 1.3%.

An age-matched comparison of subjects with binge eating disorder and bulimia nervosa

The purpose of this study was to compare data from a group of obese subjects with binge eating disorder (BED) with data from a group of normal weight bulimia nervosa (BN) subjects. Subjects were compared using the Eating Disorder Questionnaire (EDQ), the Eating Disorder Inventory (EDI), the Personality Disorders Questionnaire for DSM-III-R (PDQ-R), the Hamilton Anxiety and Depression Rating Scales, and the Beck Depression Inventory. A group of 35 age-matched subjects were selected retrospectively from treatment study subjects. The EDQ findings indicated that members of the BN group desired a lower body mass index, were more afraid of becoming fat, and more uncomfortable with their binge eating behavior than the BED group members. The BED subjects had a younger age of onset of binge eating behavior (14.3) than the BN subjects (19.8), even though both groups started dieting at a similar age (BED = 15.0, BN = 16.2). The EDI results showed BN subjects had more eating and weight-related pathology, with significantly higher scores on five of the eight subscales. On the PDQ-R more BN subjects endorsed Axis II impairment (BN = 69%, BED = 40%). While demonstrating greater eating pathology in the BN group, this study also found significant pathology and distress in BED subjects.

Binge eating in massively obese patients undergoing bariatric surgery

Data on the prevalence of binge eating in a series of 92 massively obese patients undergoing bariatric surgery are presented. A semistructured clinical interview demonstrated that 63 individuals had problems with binge eating, 43 of these reporting episodes of binge eating more than twice a week and then meeting the diagnostic criteria for binge eating disorder. By comparison with their nonbinge eating counterparts, binge eaters demonstrated higher body weight, greater weight fluctuation due to reducing diets in their past lifetime, higher Three-Factor Eating Questionnaire Disinhibition and Hunger score, and an overall higher psychopathology as assessed by the Eating Disorder Inventory. The great prevalence of binge eating in these patients could be accounted for by the high body weight, by the characteristics of the patients, or by the context in which the eating behavior assessment was carried out.

Psychopathology in subgroups of obese women with and without binge eating disorder

The examination of psychopathology in subgroups of obese patients is a new area of research in psychiatry. This project studied rates and types of psychopathology among obese subjects meeting the proposed DSM-IV criteria of binge eating disorder (BED) and obese subjects without BED. One hundred obese women with a mean age of 39.2 years and a mean body mass index (BMI) of 35.9 kg/m2 were evaluated using the Structured Clinical Interview for DSM-III-R (SCID-Modified Version) and a self-rating personality inventory, Personality Diagnostic Questionnaire-Revised (PDQ-R), before entering a treatment study for weight reduction. Those subjects meeting proposed DSM-IV criteria for BED had significantly higher lifetime rates for an axis I diagnosis compared with those that did not meet criteria for BED. Subjects with BED showed higher rates of lifetime affective disorder and bulimia nervosa, but did not differ on any other axis I diagnoses. Axis II cluster B and cluster C diagnoses were found more frequently among BED subjects. The specific diagnoses of histrionic, borderline, and avoidant personality disorders were found significantly more often among BED subjects. The results support the idea that binge eating may identify a distinct subgroup among the obese population who have significantly higher rates of certain forms of psychopathology on both Axis I and Axis II. The findings of increased rates of depression are consistent with other studies and suggest that our treatment modalities need to address this problem.

Food and mood: relationship between food, serotonin and affective disorders

The relationship of food and eating with affective and other clinical disorders is complex and intriguing. Serotoninergic dysfunction in seasonal affective disorder, atypical depression, premenstrual syndrome, anorexia and bulimia nervosa, and binge eating disorder is reviewed. Patients exhibiting a relationship between food and behaviour are found in various diagnostic categories. This points to a need to shift from nosological to functional thinking in psychiatry. It also means application of psychopharmacological treatments across diagnostic boundaries. The use of phototherapy and psychotropic drugs (MAO inhibitors and selective serotonin reuptake inhibitors like fluoxetine) in these disorders is discussed.

Eating related and general psychopathology in obese females with binge eating disorder

One hundred obese women with a mean age of 39.2 years, and a mean body mass index (BMI) of 35.9 kg/m2 were evaluated before entering a treatment study for weight reduction. According to the results of a structured interview, subjects were divided into four groups: (1) no overeating episodes, (2) episodic overeating episodes without the feeling of loss of control, (3) overeating plus the sense of loss of control (binge eating), and (4) full diagnostic criteria for binge eating disorder (BED). One-way analyses of variance (ANOVAs) revealed significant positive associations between binge eating and eating/weight-related characteristics such as a history of frequent weight fluctuations, the amount of time spent dieting, drive for thinness, and a tendency for disinhibition of eating. Furthermore, subjects exhibited more feelings of ineffectiveness, stronger perfectionistic attitudes, more impulsivity, less self-esteem, and less interoceptive awareness the more problems with binge eating they reported. The results support the idea that binge eaters might be a distinct subgroup among the obese population, and corroborate the utility of a diagnosis of BED in identifying the most disturbed obese subjects with regard to the variables tested.

Recurrent overeating: an empirical comparison of binge eating disorder, bulimia nervosa, and obesity

The goal of the study was to contribute empirical data to the discussion of appropriate diagnostic classification of obese and nonobese, binging, and nonbinging eating disordered patients. The study consists of two parts: (1) patients with binge eating disorder (BED) (N = 22) are compared to a matched sample of patients with bulimia nervosa (BN) and to 16 patients with obesity (body mass index [BMI] > 30). These patient groups were cross-sectionally assessed using expert ratings (interview) and self-ratings. (2) A sample of 68 patients with BED were assessed longitudinally on admission and discharge of inpatient treatment and at a 3-year follow-up using the same instruments as in the first study. The study is the first to report longitudinal data on patients with BED. The general pattern of the cross-sectional data was that patients with BN not only had higher scores concerning disturbances of eating behavior and attitude but also for general psychopathology when compared to patients with obesity without marked binges. The scores of patients with BED had an intermediate position between BN and obesity but were closer to BN than to obesity. The BED group (and the obesity group) showed a high degree of body dissatisfaction, which, however, was accounted for by their high body weight. Concerning general psychopathology BED as well as BN had significantly higher scores than the obesity group in the Hopkin's Symptom Checklist (SCL) subscale anger and hostility, in the Complaint List, the PERI Demoralization Scale, and the Beck Depression Inventory. Results of the longitudinal study with BED showed marked improvement in specific and general psychopathology over time. Except for body weight this improvement largely persisted over the 3-year follow-up period. Severity of depression did not predict the course of body weight over time. Data are presented concerning the design of diagnostic criteria for eating disturbed patients not fitting criteria for BN or anorexia nervosa (AN). Arguments pro and contra the introduction of a new BED category in psychiatric diagnostic criteria are discussed. Although there is generally a need for developing or revising the diagnostic criteria for recurrent bingers, our data do not support inclusion of BED (as presently defined) as a separate diagnostic category in DSM-IV.

Binge eating in the obese

This review will first describe problems in the definition of the term binge eating, especially in the absence of purging (vomiting, laxative abuse). We highlight current approaches in the classification of obesity, and then provide an overview of the available literature on differences between obese binge eaters and obese non-binge eaters. Many studies indicate that binge eating is common among the female obese, with a frequency ranging from 23 to 46% among those seeking treatment for weight reduction. Despite differences in the definitions of binge eating and variability among the samples investigated, there is strong evidence that binge eaters represent a distinct subgroup among the obese. Binge eating obese exhibit significantly more eating and weight-related pathology, as well as more psychopathology compared to their non-binge eating obese counterparts.