Binge Eating as a Diagnosis - contributed by Brian DeCicco
A study published this fall by researchers at Harvard University is the first of its kind to include “binge” eating as a diagnosis, similar to anorexia and bulimia. Attention given to eating disorders generally focus on women, especially young women, and the need to be thin. Indeed this study found that women are twice as likely as men to be diagnosed with an eating disorder. Binge eating, if widely recognized as a legitimate disorder could expand the number of males diagnosed with an eating disorder. Adolescent girls are not the only ones that battle with the size and shape of their bodies. Many adolescent males over eat or binge in the hope of packing on pounds to build muscle or to play sports likes like football or wrestling. This study could put such behaviors in a new perspective. Individuals may be creating bad habits that will persist beyond their playing days.
According to this study binge eating consists of:
1. Eating large quantities of food for 2 hours or more, 2-3 times per week
2. Feeling a lack of control
3. Experiencing feeling of regret related to binging
Skeptics of this study view it as the medical and pharmaceutical industries attempting to “medicalize” something that is just simply bad behavior. However, it is hard to ignore the growing rates of obesity in our country. Since obesity can lead to other serious health problems, such as heart disease, diabetes, and chronic fatigue, binge eating certainly warrant further research. If binge eating were made a recognized disorder this would require health insurance companies to assist patient with seeking treatments. Although, insurance companies may initially resist such a move, further research will hopefully show that the preventative measures of treating disorders such as binge eating could minimize the need for more cost treatments later in life.
http://query.nytimes.com/gst/fullpage.html?sec=health&res=9903E0D91F3FF930A25751C0A9619C8B63
February 13, 2007
Survey Puts New Focus on Binge Eating as a Diagnosis
By NICHOLAS BAKALAR
Binge eating is not yet officially classified as a psychiatric disorder. But it may be more common than the two eating disorders now recognized, anorexia nervosa and bulimia.
The first nationally representative study of eating disorders in the United States, a nationwide survey of more than 2,900 men and women, was published by Harvard researchers in the Feb. 1 issue of the journal Biological Psychiatry. It found a prevalence in the general population of 0.6 percent for anorexia, 1 percent for bulimia and 2.8 percent for binge-eating disorder.
Lifetime rates of the disorders, the researchers found, are higher in younger age groups, suggesting that the problem is increasingly common. Eating disorders are about twice as common among women as men, the study reports.
Experts not involved in the study called it significant. ''This is probably the best study yet conducted of the frequencies of eating disorders in American households,'' said Dr. B. Timothy Walsh, director of the eating disorders research unit of the New York State Psychiatric Institute at Columbia University Medical Center.
''It confirms that anorexia nervosa and bulimia are uncommon but serious illnesses, especially among women,'' Dr. Walsh said. ''It also finds that many more individuals, especially those with significant obesity, are troubled by binge eating, and underscores the need to better understand this problem.''
The survey, partly financed by two pharmaceutical companies, was carried out from 2001 to 2003 among adults 18 and older, and the diagnoses were established using face-to-face interviews.
While all three eating disorders appear in the American Psychiatric Association's diagnostic bible, the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M.-IV, binge eating disorder is not considered a definitive diagnosis like anorexia and bulimia. Rather, it is one of a number of categories requiring further study.
Some suspect that establishing binge eating disorder as a psychiatric diagnosis is merely an attempt by psychiatrists or drug companies to ''medicalize'' what would otherwise be considered simply ordinary, if unfortunate, human behavior. Cynthia M. Bulik, director of the eating disorders program at the University of North Carolina, Chapel Hill, does not see it this way.
''It's patients who want this in the D.S.M. so they can get treatment,'' Dr. Bulik said. ''I've gotten e-mails from people saying, 'Thanks for putting a name on this binge-eating disorder.'
''The disorder has no diagnostic label that will get them insurance payments,'' she continued. ''They have a nasty syndrome with serious health implications, knowing that there is evidence-based treatment available and not being able to get it because it's not officially recognized as a diagnosis.''
The diagnosis of binge eating disorder requires that a person eat an excessively large amount of food in a two-hour period at least twice a week for six months, feel a lack of control over the episodes, and experience marked distress regarding the practice.
Marlene B. Schwartz, the director of research and school programs at the Rudd Center for Food Policy and Obesity at Yale, who had no role in the study, said binge-eating disorders were ''not a matter of just eating too much every now and then.''
''The diagnosis requires the feeling that you can't stop,'' Dr. Schwartz said. ''And it's that loss of control that makes it a psychiatric disorder different from someone just overindulging every now and then.''
Dr. James I. Hudson, the lead author of the new study, said binge eating was associated with obesity, particularly severe obesity. ''This brings in a lot of medical consequences and suggests it's a major health problem,'' he said. ''This information will help us make decisions on public health policy.'' Dr. Hudson is director of the psychiatric epidemiology research program at McLean Hospital in Belmont, Mass., and a professor of psychiatry at Harvard.
A diagnosis of anorexia requires a refusal to maintain at least 85 percent of normal weight and a distinctly distorted view of one's weight or body shape. Bulimia is characterized by recurrent episodes of binge eating at least twice a week for three months and then compensating for the behavior, usually by self-induced vomiting or abuse of laxatives and other medicines.
Eating disorders, the researchers found, are commonly accompanied by other psychiatric illnesses. In the survey, more than half of the people with bulimia had major depression, 50 percent had phobias and more than one-third had a substance abuse disorder. Over all, more than 94 percent of people with bulimia, 56 percent of those with anorexia and 79 percent of those with binge-eating disorder had at least one other psychiatric diagnosis.
Dr. Hudson said the most significant limitation of the study was its basis on self-reports, explaining that people tend to underreport their problems with eating disorders. So the true prevalence, he said, is probably higher than reported.
''Obesity is an endpoint, and there are many pathways in,'' Dr. Bulik said. ''One of the things I look for is modifiable behavioral factors. This study shows now that binge eating disorder is relatively prevalent. For a certain percentage of the population, this is a modifiable behavior.''