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Binge eating disorder (BED) affects far more people than anorexia or bulimia, yet it receives a fraction of the attention. In fact, this disorder had been relegated to an appendix of the DSM-IV (TR) while the other eating disorders are front and center. Affecting between 2-3 percent of all adults, 10-15 percent of mildly obese people, and greater numbers of severely obese people, BED is finally receiving some attention (National Institute of Diabetes and Digestive Kidney Diseases: Weight-Control Information Network, 2010). An American Psychiatric Association workgroup has drafted proposed criteria for inclusion of BED in the DSM-V. This criterion includes (American Psychiatric Association, 2010):
  1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    1. Eating, in a discrete period of time (e.g., within any two-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
    2. Sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating
  2. The binge-eating episodes are associated with three (or more) of the following:
    1. Eating much more rapidly than normal
    2. Eating until feeling uncomfortably full
    3. Eating large amounts of food when not feeling physically hungry
    4. Eating alone because of being embarrassed by how much one is eating
    5. Feeling disgusted with oneself, depressed, or very guilty after overeating
  3. Marked distress regarding binge eating is present
  4. The binge eating occurs, on average, at least once a week for three months
  5. The binge eating is not associated with the recurrent use of inappropriate compensatory
Those with BED are more likely to be diagnosed with Axis I and II mental disorders, especially depression, generalized anxiety disorder, and panic attacks, than obese people who do not binge eat. In fact, approximately 80 percent of those with BED have co-occurring disorders. They are also likely to use alcohol, act impulsively, feel isolated, feel out of control, and have suicidal thoughts (Wonderlich, Gordon, Mitchell, 2009). Those who suffer from BED are more likely to be female, white, and have a higher BMI than obese individuals who do not binge eat (Kolotkin, Westman, Ostby, Crosby, Eisenson, Binks, 2004).

BED responds to various forms of treatment, including cognitive behavioral therapy and antidepressant medications. A combination of the two treatment modalities is often used. Antidepressants have not been shown to be effective in treating obesity when BED is not present (Wonderlick, et al, 2009).

It is important that you are aware that many of your obese students, especially those with co-occurring depression or anxiety, may binge eat. It is important to screen students for this disorder and provide short-term counseling in accordance with the PRH. A multidisciplinary approach involving the Center Physician and Health and Wellness Manger is recommended. Refer students to a community resource that specializes in eating disorders if appropriate.


Sources
American Psychiatric Association. (2010). Binge Eating Disorder. Retrieved online September 17, 2010 from http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=372.

Kolotkin, R.L., Westman, E.C., Ostby, T., Crosby, R.D., Eisenson, H.J., Binks, M. (2004). Does binge eating disorder impact weight-related quality of life? Obesity Research. 12, 999-1005.

National Institute of Diabetes and Digestive Kidney Diseases: Weight-Control Information Network. (2010). Binge Eating Disorder. Retrieved online September 17, 2010 from http://www.win.niddk.nih.gov/publications/binge.htm.

Wonderlich, S.A., Gordon, K.H., Mitchell, J.E., et al. (2009). The validity and clinical utility of binge eating disorder. International Journal of Eating Disorders. 42 (8), 687-705.

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