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Binge Eating Disorder: Surprisingly Common, Seriously Under-treated

(PSYCHIATRIC TIMES) - Though binge eating is not an officially recognized psychiatric disorder, it is more common than anorexia nervosa and bulimia; carries serious health risks; can be chronic; transcends racial, gender and socioeconomic boundaries; and frequently occurs along with other mental disorders.

Given these findings -- taken from the first nationally representative survey of eating disorders in the U.S. -- experts say physicians should routinely screen for binge eating disorder, especially among overweight and obese patients. Mental-health clinicians, in particular, are in a good position to recognize and treat the disorder, and the issues of low self-esteem and poor body image that often accompany it.

Most physicians, however, aren't aware of the problem, says James Hudson, MD, director of the Psychiatric Epidemiology Research Program at McLean Hospital and a professor of psychiatry at Harvard.
"Doctors have a reasonable degree of awareness about anorexia and bulimia, but they're not tuned into binge eating. It's just not as well known," says Hudson, lead author of "The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication". The study, published Feb. 1 in Biological Psychiatry, found that 2.8 percent of the general population has binge-eating disorder -- more than bulimia (1 percent prevalence) and anorexia (0.6 percent) combined. Findings reveal 'major public health problem'

The study also found that:

* Binge eating disorder (BED) is strongly associated with severe obesity, which can lead to diabetes, heart disease, hypertension and stroke.
* Although eating disorders overall are about twice as common among women as men, 40 percent of binge eaters are men.
* 78.9 percent of those with binge eating disorder met the criteria for at least one other psychiatric disorder, and 48.9 percent met the criteria for three or more psychiatric disorders.
* No single class of mental disorders stood out as being consistently associated with BED. Among those with binge eating disorder, 31.9 percent also met the criteria for social phobia, 32.3 percent for major depressive disorder, 26.3 percent for post-traumatic stress disorder; 23.3 percent for any substance use disorder, and 65.1 percent for any anxiety disorder.
* 62.6 percent of those with BED reported at least some role impairment at home, work and/or in their social life.
* The average duration of BED was 8.1 years, compared with 8.3 for bulimia and 1.7 for anorexia.
* Less than half of those with binge eating disorder had sought treatment for it.

"Binge eating disorder represents a major public health problem," Hudson said. "It is imperative that health experts take notice of these findings."

While physicians are well aware of bulimia and anorexia, they tend to overlook binge eating, for reasons including its lack of obvious physical signs and its lack of official recognition. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) currently classifies BED as an "eating disorder not otherwise specified" and needing further study. Many researchers, however, believe there is now sufficient evidence to classify it as a separate disorder. A working group for the next (fifth) edition of the DSM, to be published in 2012, is being formed to discuss and will decide the question.

Detection is also hampered by physicians' reluctance to raise the issue of eating disorders, Hudson notes. "It makes the doctor uncomfortable; it makes the patient uncomfortable. I don't like to ask about it myself. But we need to be asking about it."

Questions to ask
Since binge eating is most common among the overweight and obese, those populations are the logical place to start screening. Since binge eating is most common among overweight and obese patients, those populations are the logical place to start screening. Binge eating is even more likely in overweight patients with low self-esteem and a poor body image.

Ruth Striegel-Moore, PhD -- professor and chair of psychology at Wesleyan University and past president of the Academy for Eating Disorders -- suggests starting the conversation with a simple question: "Do you feel you have any problems with your eating?"

If the patient says yes, the clinician should ask about these key signs of BED:

* Do you eat unusually large amounts of food at one sitting (equivalent to two full meals)?
* Do you eat this way even when you're not hungry?
* Do you eat until you're uncomfortably full?
* Do you feel you've lost control and can't stop eating?
* Do you feel ashamed or depressed afterwards?
* Has this happened two or more times a week for six months?
* Do you eat alone because you're embarrassed to eat around others?

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