Binge eating disorder (BED)

ICD-10F50.8	Other eating disorders
DSM-5-TRF50.81	Binge-Eating Disorder

1. Definition and nosology

Binge-Eating Disorder (BED) (ICD-11: 6B82; DSM-5-TR: F50.81) — recurrent episodes of binge eating (large amount of food in a short period + sense of loss of control), without compensatory behaviors. Weight is typically increased, often with obesity.

2. History

1. Stunkard A.J. (1959) — description of binge eating in the context of obesity.
2. DSM-IV (1994) — Listed in the research appendix.
3. DSM-5 (2013) — separate official diagnosis.

3. Epidemiology

• Lifetime prevalence: 1.9–3.5%; most common among eating disorders.
• Sex: 1.5–2:1 in females; but also significant in males.
• Strong association with obesity.
• Comorbidity: MDD, anxiety, BPD, substance use.

4. Etiology and pathogenesis

• Heritability 40–50%.
• Neurobiological — reward circuit dysregulation; ‘food addiction’ hypothesis.
• Emotional eating — stress trigger.
• History of restrictive diet.

5. Clinical features

• Binge eating episodes — large amount of food in short time, loss of control.
• Typical features: rapid eating, continuing despite fullness, secretive eating, subsequent shame, guilt.
• No compensatory behavior.
• Weight gain and obesity complications (Type 2 diabetes, cardiovascular, hepatic steatosis).

6. Diagnosis

6.1 Unified diagnostic criteria

A. Repeated binge eating episodes.

B. Episodes associated with at least 3 of the following:

• Rapid eating
• Eating until physically full;
• Binge eating without hunger;
• Secretive eating (due to shame);
• Feeling disgusted with oneself, depressed, or very guilty afterward.

C. Significant distress.

D. Frequency: 1 time per week, ≥3 months.

E. Does not occur in the context of bulimia or anorexia; no compensatory behavior.

6.2 Differences between sources

1. DSM-5-TR — severity based on episode frequency.
2. ICD-11 — no severity scale: DSM-5-TR grades by episode count (mild 1–3, moderate 4–7, severe 8–13, extreme ≥14 per week), whereas ICD-11 says only “once a week or more over a period of several months”.

6.3 Diagnostic algorithm

• Clinical interview.
• EDE-Q.
• Medical assessment — metabolic syndrome screening (glucose, HbA1c, lipids, blood pressure).
• Comorbidity.

6.4 Differential diagnosis

7. Examination and assessment

1. EDE-Q.
2. BMI, weight, vital signs.
3. Metabolic panel.

8. Treatment

• CBT-E first-line — Wilson G.T. et al.’s randomized trial indicated a significant effect in BED.
• Lisdexamfetamine (Vyvanse) — start 30 mg/day, increase by 20 mg weekly to 50–70 mg/day (maximum 70 mg/day) — FDA approval for BED; significantly reduces binge-eating frequency (McElroy S.L. JAMA Psychiatry 2015).
• SSRI — for comorbid MDD; modest effect on binge eating frequency.
• IPT alternative.
• Weight management — diet, physical activity; weight loss is not effective without BED intervention.
• Bariatric surgery requires long-term follow-up (BED preoperative assessment).

8.1 Treatment methods

1. CBT-E for BED — Breaking the binge cycle, alternative coping.
2. Lisdexamfetamine — FDA approval for BED; start 30 mg, target 50–70 mg/day.
3. IPT — Focus on interpersonal issues.
4. Guided Self-Help CBT (Guided Self-Help) — Internet-based, book-based.

8.2 Differences between sources

1. NICE NG69 — CBT or guided self-help first-line.
2. APA 2023.
3. McElroy lisdexamfetamine RCTs.

9. Prognosis

• 50–60% remission with CBT-E.
• Weight management and metabolic complications require long-term monitoring.

10. Myths and misconceptions

Myth 1: “BED is just obesity or an ‘overeating’ personality trait”

Evidence: Clinical eating disorder; distinguished from an isolated binge eating episode by loss of control and shameful eating (loss of control, shameful eating).

Myth 2: “Restrictive diet cures BED”

Evidence: Restrictive diet triggers BED — weight control without psychological intervention increases binge eating.

Myth 3: “Bariatric surgery cures BED”

Evidence: Surgery reduces gastric capacity but does not modify the cognitive-behavioral component; in some patients, a new pattern of “grazing” develops.

Myth 4: “Eating is an ‘addiction’ (food addiction), must be treated like drugs”

Evidence: “Food addiction” is a concept but not accepted as a clinical diagnosis; standard eating disorder interventions are superior.

Myth 5: “BED only requires an antidepressant”

Evidence: lisdexamfetamine FDA approval for BED; CBT first-line.

11. Sources

• WHO. ICD-11. 6B82 Binge eating disorder. 2024.
• APA. DSM-5-TR. 2022.
• NICE NG69. 2017/2020.
• McElroy S.L. et al. Efficacy and safety of lisdexamfetamine for treatment of adults with moderate to severe binge eating disorder. JAMA Psychiatry 2015;72(3):235–246.
• Wilson G.T., Wilfley D.E., Agras W.S., Bryson S.W. Psychological treatments of binge eating disorder. Arch Gen Psychiatry 2010;67(1):94–101.