● Age: Binge-eating disorder often starts in a person’s late teens or early 20s, but people of any age can develop binge- eating disorder. ● Brain chemicals and metabolism: Researchers are studying whether brain chemicals and metabolism affect the development of binge-eating disorder. ● Dieting: Many people affected by binge-eating disorder have a history of frequent dieting, sometimes starting in childhood. Dieting may increase the need to binge eat. This seems to be especially true if the client has a history of depression or substance abuse. ● Psychological issues: The majority of people with binge- eating disorder are overweight and quite self-conscious about their appearance. They may use binging as a way to deal with stress, but they feel that they have little or no control over these inappropriate behaviors. Affected persons do not have healthy ways of coping with anger, stress, worry, anxiety, or even boredom. They may also have a history of depression or substance abuse. ● Family history: A family history of eating disorders increases risk. Genetic influences might contribute to the development of eating disorders. Healthcare professionals, some of whom are experts in the field of eating disorders, question whether it is possible to prevent the development of binge-eating disorder. Although prevention may not be possible, teaching and encouraging healthy eating habits and realistic attitudes about food, body image, and self-perception at an early age (and continuing throughout school and college years) may help to prevent the development or exacerbation of the disease (Mayo Clinic, 2018f; WebMD, 2017b). Clinical Presentation Gerald has been slightly overweight since he was a child. He is now 30 years old, and his wife, who is an RN, is encouraging him to lose weight. She is concerned that he is gaining weight and often eats excessively large meals at a rapid pace. Gerald’s wife has heard colleagues discuss binge-eating disorder, and she asks them to explain the essential characteristics of the disease. The DSM-5 describes several characteristics or features that are seen in people who suffer from binge-eating disorder (American Psychiatric Association, 2013): ● Recurrent episodes of binge eating ● Binge eating associated with eating more rapidly than normal until uncomfortably full, eating large amounts of food when not actually hungry, eating alone, and feeling disgusted by binging behaviors ● Significant distress associated with binging ● Binge eating occurring at least once a week for three months ● Purging behaviors not present According to DSM-5, Binge Eating Disorder (BED) affects approximately 1.5% of women and 0.3% of men worldwide, with a lifetime diagnosis reported by 0.6-1.8% of women and 0.3- 0.7% of men. During adolescence, BED is more prevalent but often temporary. Many adults with BED experience long-lasting symptoms, but healthcare recognition is less than satisfactory, with less than half being acknowledged. BED is frequently associated with obesity, type 2 diabetes, and hypertension. In a US-based study, up to 23% of individuals with BED had attempted suicide, and nearly all (94%) reported lifetime mental health symptoms, including mood disorders (70%), substance use disorders (68%), anxiety disorders (59%), borderline personality disorder (49%), and posttraumatic stress disorder (32%). Limited data on mortality show that the standardized mortality ratio for BED is estimated to be 1.5-1.8. Factors such as minority statuses, deprivation, violence, trauma, and major mental illness may increase the risk of developing BED (Keski- Rahkonen, 2021). Other Disorders and Binge-Eating Disorder It is important to differentiate between binge-eating disorder and other diseases or problems. Binging may be part of other
health issues, but not necessarily part of the diagnostic criteria for binge-eating disorder. Obesity and Binge-Eating Disorder Binge-eating disorder is associated with being overweight and obesity. Here are several signs displayed by clients that nurses should be aware of as they relate to binge-eating disorder and obesity (Mayo Clinic, 2018f): ● Poor quality of life ● Difficulties functioning at work, with interpersonal relationships, and in social situations ● Social isolation ● Medical conditions associated with obesity such as joint problems, cardiovascular disease, type 2 diabetes, gastroesophageal reflux disease (GERD), and some sleeping- related breathing disorders Bulimia Nervosa It is important to distinguish between bulimia nervosa and binge- eating disorder. Here are some distinguishing characteristics (American Psychiatric Association, 2013): ● Purging behaviors (self-induced vomiting, laxative abuse) present in bulimia nervosa are not present in binge-eating disorder. ● Unlike those persons with bulimia nervosa, individuals who suffer from binge-eating disorder typically do not show “marked or sustained dietary restriction designed to influence body weight and shape between binge-eating episodes.” However, they may report frequent attempts to diet. ● Response to treatment also differs among those who have bulimia nervosa and those who have binge-eating disorder. Rates of improvement are consistently higher among individuals with binge-eating disorder than among those with bulimia nervosa. Bipolar and Depressive Disorders Both appetite increase and weight gain are part of the criteria for major depressive episode and in the atypical features specified for depressive and bipolar disorders. Binge eating and other symptoms of disordered eating are found in association with bipolar disorders. If complete criteria are met for both disorders, both diagnoses are given and the disorders are considered to coexist (American Psychiatric Association, 2013). Borderline Personality Disorder Binge eating is included as part of the impulsive behavior criterion that is part of the definition of borderline personality disorder. If all criteria are met for both disorders, both diagnoses are given (American Psychiatric Association, 2013; Staycer, 2017). Healthcare consideration : Binge-eating disorder is associated with significant coexistence of other mental health disorders (as are anorexia nervosa and bulimia nervosa). The most common coexisting disorders are bipolar disorders; depressive disorders; anxiety disorders; and, to a lesser extent, substance use disorders. Note that the coexistence of other conditions is linked to the severity of the binge eating and not to the extent of the obesity (American Psychiatric Association, 2013; Mayo Clinic, 2018f). Pathophysiology and Complications Related to Binge-Eating Disorder The pathophysiology of binge-eating disorder is primarily related to complications associated with weight gain. Here are some complications that may be caused by, or associated with, excessive weight because of binge-eating disorder (Mayo Clinic, 2018f; WebMD, 2017b). Hypertension Hypertension is defined as an intermittent or sustained elevation in diastolic or systolic blood pressure. Obesity is a significant risk factor for hypertension (Gersch et al., 2017).
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