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Binge eating disorder

Nature Reviews Disease Primers volume 8, Article number: 16 (2022) Cite this article

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Abstract

Binge eating disorder (BED) is characterized by regular binge eating episodes during which individuals ingest comparably large amounts of food and experience loss of control over their eating behaviour. The worldwide prevalence of BED for the years 2018–2020 is estimated to be 0.6–1.8% in adult women and 0.3–0.7% in adult men. BED is commonly associated with obesity and with somatic and mental health comorbidities. People with BED experience considerable burden and impairments in quality of life, and, at the same time, BED often goes undetected and untreated. The aetiology of BED is complex, including genetic and environmental factors as well as neuroendocrinological and neurobiological contributions. Neurobiological findings highlight impairments in reward processing, inhibitory control and emotion regulation in people with BED, and these neurobiological domains are targets for emerging treatment approaches. Psychotherapy is the first-line treatment for BED. Recognition and research on BED has increased since its inclusion into DSM-5; however, continuing efforts are needed to understand underlying mechanisms of BED and to improve prevention and treatment outcomes for this disorder. These efforts should also include screening, identification and implementation of evidence-based interventions in routine clinical practice settings such as primary care and mental health outpatient clinics.

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Fig. 1: Timeline of the evolution of classification criteria for BED.
Fig. 2: Lifetime prevalence of BED.
Fig. 3: Schematic display of pathways of gut–brain communication.
Fig. 4: Food intake regulation.
Fig. 5: Brain circuits involved in the pathopsychology of BED.

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Acknowledgements

U.S. acknowledges salary support from the National Institute of Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) at the South London and Maudsley NHS Foundation Trust and King’s College London. She is also supported by an NIHR Senior Investigator Award. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. C.M.B. is supported by NIMH (R01MH120170, R01MH124871, R01MH119084, R01MH118278, R01 MH124871); Brain and Behavior Research Foundation Distinguished Investigator Grant; Swedish Research Council (Vetenskapsrådet, award 538-2013-8864); Lundbeck Foundation (grant no. R276-2018-4581). S.Z. was supported by the publicly funded project INTERBED (01GV0601) of the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung (BMBF)). F.F.-A. is supported by CERCA Programme/Generalitat de Catalunya for institutional support, and by research grants from PERIS (SLT006/17/00246), Instituto Salud Carlos III (PI17/01167, PI20/132, CIBERobn) and EU-H2020 grants (Eat2beNICE/H2020-SFS-2016-2, ref. 728018; and PRIME/H2020-SC1-BHC-2018-2020, ref. 847879) and COST Action (CA19115). K.S. is supported by a grant from the Margarete von Wrangell Program by the Federal Ministry of Science and Education Baden-Württemberg. K.E.G. acknowledges grants from the Federal Ministry of Education and Research (BMBF) (01KG2009) and the German Research Foundation (DFG) (GI 878/4-1). The authors thank the patient for anonymously sharing personal experiences of BED.

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Authors and Affiliations

  1. Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany

    Katrin E. Giel, Kathrin Schag & Stephan Zipfel

  2. Center of Excellence for Eating Disorders (KOMET), Tübingen, Germany

    Katrin E. Giel, Kathrin Schag & Stephan Zipfel

  3. Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Cynthia M. Bulik

  4. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Cynthia M. Bulik

  5. Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Cynthia M. Bulik

  6. Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain

    Fernando Fernandez-Aranda

  7. Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain

    Fernando Fernandez-Aranda

  8. Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain

    Fernando Fernandez-Aranda

  9. Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia

    Phillipa Hay

  10. Camden and Campbelltown Hospitals, SWSLHD, Campbelltown, NSW, Australia

    Phillipa Hay

  11. Department of Public Health, University of Helsinki, Helsinki, Finland

    Anna Keski-Rahkonen

  12. Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK

    Ulrike Schmidt

  13. South London and Maudsley NHS Foundation Trust, London, UK

    Ulrike Schmidt

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Contributions

Introduction (K.E.G.); Epidemiology (A.K.-R.); Mechanisms/pathophysiology (C.M.B. and F.F.-A.); Diagnosis, screening and prevention (K.S., K.E.G. and S.Z.); Management (P.H. and U.S.); Quality of life (P.H.); Outlook (K.E.G.); Overview of Primer (K.E.G.).

Corresponding author

Correspondence to Katrin E. Giel.

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Competing interests

C.M.B. received a grant from Shire, was a member of the Shire Scientific Advisory Board, acted as a consultant for Idorsia, received a grant from Lundbeckfonden, acted as an author for and received a grant from Pearson, and was a member of the Equip Health Inc. Clinical Advisory Board. F.F.-A. received consultancy honorarium from Novo Nordisk and an editorial honorarium as editor-in-chief from Wiley. P.H. is a consultant to Takeda Pharmaceuticals, receives or has received sessional fees and lecture fees from the Australian Medical Council, Therapeutic Guidelines publication, and New South Wales Institute of Psychiatry, and royalties/honoraria from Hogrefe and Huber, McGraw Hill Education, Blackwell Scientific Publications, BioMed Central and PLOS Medicine, and has received research grants from the NHMRC and ARC. She is Chair of the National Eating Disorders Collaboration Steering Committee in Australia and was a member of the ICD-11 Working Group for Eating Disorders and was Chair of the Clinical Practice Guidelines Project Working Group (Eating Disorders) of RANZCP. All views expressed in this paper are her own. All other authors declare no competing interests.

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Nature Reviews Disease Primers thanks M. Fennig, A. C. Grammer, C. Segura-Garcia, F. Thomas, D. Wilfey and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Giel, K.E., Bulik, C.M., Fernandez-Aranda, F. et al. Binge eating disorder. Nat Rev Dis Primers 8, 16 (2022). https://doi.org/10.1038/s41572-022-00344-y

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