Binge eating disorder: what is it, symptoms, causes, treatment, prognosis

What is binge eating disorder?

Compulsive overeating (or psychogenic overeating) Is a condition characterized by episodes of eating more food than usual in a short time. These episodes take place every week for three months. This is an individual diagnosis, different from bulimia nervosa. Binge eating is associated with a variety of psychological and non-psychological problems, with some degree of disruption to daily life and some serious medical conditions. Common medical disorders such as obesity, diabetes, hypertension and chronic pain are some of the comorbidities. Psychogenic overeating is most often seen in obese people, but is not limited to them. People with binge eating disorder complain of weight gain. The prevalence of this disorder increases with weight gain, and obesity is a common comorbid condition.

Causes and risk factors

Binge eating disorder can result from a variety of psychological, social, cultural, and biological factors. Some of the risk factors for binge eating disorder include:

• childhood obesity;
• lack of controlled nutrition in childhood;
• perfectionism;
• behavior problems;
• substance abuse;
• family problems with excess weight and nutritional problems;
• family conflicts and problems with raising children;
• parental psychopathology;
• physical and sexual abuse;
• mental health problems;
• the involvement of genes for mu-opioid receptors (eg OPRM1) and dopamine (eg DRD2);
• distorted perception of the body image;
• changes in the gut microbiota.

Epidemiology

Binge eating is more common in women than in men and usually occurs around the age of 23. The lifetime prevalence of this disorder is 2.6%. Approximately 79% of people with binge eating disorder have one mental disorder; 49% of patients had two or more comorbidities throughout their life. Common comorbid conditions with binge eating disorder include:

1. Specific phobia (37%).
2. Social phobia (32%).
3. Post-traumatic stress disorder (26%).
4. Alcoholism or addiction (21%).

Pathophysiology

Binge eating disorder shares the same neurobiology as substance use disorder. Research has proposed several models to explain the pathophysiology of binge eating disorder. This is due to the complexity of reward processing and inhibitory control. An outstanding model of affect regulation emphasizes the role of negative affect in eating disorder with overeating. According to this model, episodes of overeating are caused by negative affect and help to get rid of them. Difficulty in emotional regulation and decreased emotional awareness are correlated with binge eating disorder. In addition, interpersonal problems are associated with this disorder. In addition, neuroimaging studies have shown overactivity of the medial orbitofrontal cortex and hypoactivity of the prefrontal network in overeating individuals.

The food addiction hypothesis states that people with high impulsivity and sensitivity to rewards are addicted to certain foods, such as high-content foods sugar and fat. However, they do not develop tolerance and show no withdrawal symptoms.

An increased volume of the islet of the left orbitofrontal cortex is a known factor in malnutrition. The islet and the frontal operculum are two areas of the brain responsible for processing basic sensory information about food. The ventral striatum, which includes the nucleus accumbens, the putamen, and the caudate, is responsible for evaluating and determining the usefulness of food. The posterior caudate, ventrolateral prefrontal cortex, parietal cortex, and dorsal anterior cingulate cortex are areas of the brain responsible for controlling food responses. Patients with binge eating disorder exhibit low impulse control activity in the prefrontal cortex, inferior frontal gyrus, ventrolateral prefrontal root, and insular lobe.

Polymorphism of the serotonin D and Mu opioid receptor serotonin transporter is associated with overeating.

Diagnostics

- Anamnesis.

The clinician should be aware of the following points to help diagnose patients with binge eating disorder.

1. Age of onset of binge eating episodes.
2. Frequency of episodes of binge eating.
3. Length of episodes.
4. The amount of food.
5. Feelings associated with overeating.
6. Any compensatory behavior (vomiting, taking laxatives).
7. Comorbid conditions (psychological problems, obesity, diabetes).
8. Emotional triggers (rejection and stress).
9. Social pressure.
10. Emotional abuse in childhood.
11. Childhood calorie restriction or childhood eating disorder.
12. Suicidal thoughts.
13. Substance abuse.
14. Physical and sexual abuse.
15. Body image perception.
16. Family history of binge eating.

- Physical examination.

The patient should be screened for comorbidities associated with binge-eating obesity.

1. Regular blood pressure checks are required.
2. Blood glucose levels require regular monitoring.
3. Inspection is required for physical or sexual abuse if there is serious suspicion.

- Differential diagnosis.

Diseases that fall under the differential diagnosis of binge eating disorder are as follows:

• Bulimia nervosa - binge eating disorder differs from bulimia nervosa in that after eating there is no compensatory behavior (misuse of laxatives, fasting, or self-induced vomiting) to prevent weight gain.
• Anxiety disorder - Anxiety disorder is also associated with overeating; however, a person will be diagnosed with binge eating disorder only if an episode of binge eating occurs every week for three months.
• Kleine-Levin syndrome - periodic episodes of excessive sleepiness (hypersomnia) and narrowing of consciousness.
• Affective disorders (mood disorders) - episodes of binge eating occur along with other psychological characteristics of a mood disorder.

Treatment

The following treatments can help:

• Cognitive Behavioral Therapy can help control binge eating for a long time, but it is almost ineffective in weight loss.
• Interpersonal therapy is as effective as cognitive behavioral therapy, but also has almost no effect on weight loss.
• Stimulant drugs (for example, used to treat ADHD) and selective serotonin reuptake inhibitors (one antidepressant), such as fluoxetine, can help people stop binge eating for a short period of time and lead to weight loss.
• Slimming products (such as orlistat) or appetite suppressants (such as topiramate) can help you lose weight.
• Organized self-help groupswhich are based on the same principles as Alcoholics Anonymous (for example, Gluttony Anonymous or "Food Addicts Anonymous") are widespread, but their effectiveness is not proven.
• Traditional behavioral programs for weight loss can help people lose weight and stop binge eating disorder for a short period of time, but people tend to return to binge eating disorder.
• Can be held surgical interventionbut its effect on binge eating disorder has not been determined.

Forecast

Long-term studies show that binge eating disorder has a better prognosis than other eating disorders with more favorable remission rates. The progression of psychogenic binge eating into other eating disorders is very small. Only a few studies report an increased likelihood of going to bulimia nervosa. Depression symptoms and substance abuse, two important mental health outcomes of binge eating disorder.

Childhood binge eating predicts excess weight gain in adolescents and young women. It also independently increased the risk of obesity-related complications, such as metabolic syndrome.

Complications

Most binge eating patients are obese. Binge eating disorder and obesity coexist in most cases and have common complications. Complications of these two disorders include:

• muscle pain;
• pain in the neck, shoulder and lower back;
• worsening as a result of physical health problems after adjusting BMI;
• arterial hypertension;
• diabetes;
• asthma - respiratory disease;
• coronary heart disease and heart failure;
• hyperlipidemia;
• weight gain;
• violation menstrual cycle (amenorrhea, oligomenorrhea);
• an imbalance in cortisol hormones (a dull response of cortisol to a stress test and a decrease in urinary cortisol levels);
• oncology (colon cancer, breast, endometrium, gallbladder cancer and etc.);
• osteoarthritis;
• sleep apnea;
• obesity-hypoventilation syndrome;
• non-alcoholic fatty liver disease;
• disease gallbladder;
• metabolic syndrome.