Binge Eating Disorder – Diagnosis Criteria and Barriers Faced with Physicians, a Review of Kornstein et al., 2016

Binge Eating Disorder (BED) was first introduced as a distinct eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), yet remains under-diagnosed and under-treated.  BED is characterized by recurrent binge-eating episodes that occur during a discrete period of time, consist of the consumption of more food than is typical of most people under similar circumstances, and are associated with feelings of loss of control over eating and marked distress¹. Even though BED is more prevalent than other eating disorders, treatment rates remain low, particularly among populations of color. Data from the World Health Organization World Mental Health Survey <40% of individuals with a lifetime diagnosis of BED have ever been treated for an eating disorder¹.

Below are three things to overcome when examining BED in a clinical setting:

1. Individuals with binge-eating disorder may exhibit medical and psychiatric comorbidities that can impair quality of life and functionality without adequate treatment¹.

Individuals with BED are at an increased lifetime risk for developing type 2 diabetes and high blood pressure compared to individuals without eating disorders, with the risk of type 2 diabetes in individuals with BED being elevated in African Americans¹. Psychiatric comorbidities are also associated with BED, with 30-80% of individuals who suffer from BED having lifetime comorbid mood or anxiety disorders. Other psychiatric comorbidities include gambling problems, bipolar disorder, substance use, and avoidant, obsessive-compulsive, and borderline personality disorders. If left untreated, these comorbidities can impair quality of life and functionality¹.

2. Overcoming primary care physician and patient-related barriers is critical to accurately diagnosing and appropriately treating binge-eating disorder¹.

Primary care physicians (PCPs) may find diagnosing and treating BED challenging due to insufficient knowledge of its new diagnostic criteria and available treatment options. However, a majority of survey respondents reported seeing a general physician for binge-eating-related symptoms. Unfortunately, individuals with obesity and with BED may be told to focus on weight management rather than their binge-eating behaviors¹. Furthermore, individuals with BED may be reluctant to seek treatment because of shame, embarrassment, and a lack of awareness of the disorder¹.

3. Primary care physicians should take an active role in the initial recognition and assessment of suspected binge-eating disorder, the initial treatment selection, and the long-term follow-up of patients who meet DSM-5 diagnostic criteria¹.

PCPs should consider their patients’ clinical history and potential environmental stressors to determine if BED risk factors are present. It is recommended that PCP routinely ask about eating habits and monitor changes in body weight as a part of a complete patient history¹. However, assessing weight and BMI is not sufficient to determine if a patient has BED, and physicians need to be careful when discussing weight with patients. As mentioned before, shame and guilt are frequently seen in individuals with BED, so a reluctance to discuss eating habits could be an indicator for BED¹. Pharmacotherapy and psychotherapy should focus on reducing stressors that contribute to binge-eating behavior, thereby reducing further medical and psychiatric complications¹.

In conclusion, overcoming primary care physician and patient-related barriers is critical to accurately diagnose and treat BED. Physicians should take an active role in the initial recognition and assessment of suspected BED, the initial treatment selection, and the long-term follow-up of patients with BED¹. Recommended strategies include taking care to convey a nonjudgmental interest in helping the patient, communicating that eating disorders are of medical concern, and using motivational interviewing principles to establish agreed-upon goals are may be helpful to patients with BED¹.

References:

1. Kornstein, S. G., Kunovac, J. L., Herman, B. K., & Culpepper, L. (2016). Recognizing Binge-Eating Disorder in the Clinical Setting: A Review of the Literature. The Primary Care Companion for CNS Disorders, 18(3). doi: 10.4088/PCC.15r01905