Binge-Eating Disorder (BED) Clinical Presentation

Updated: Apr 10, 2017
  • Author: Bettina E Bernstein, DO; Chief Editor: David Bienenfeld, MD  more...
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Presentation

History

A youth or adult at high risk for binge-eating disorder (BED) is likely to binge in response to emotional triggers such as abandonment, loss, or work or school-related stress. The impact of societal pressures should not be ignored; media inputs such as movies, television, and the internet often show eating large portions of ice cream as an accepted method to cope with stress (eg, of a relationship breakup). Genetic factors, such as a family history of obesity or binge-eating disorder, should also be considered. [9]

Binge-eating disorder can present in childhood, and the history may reveal that the patient experienced or witnessed disordered eating behavior as they were growing up. A small but well-conducted longitudinal study of adolescent females with early childhood experience of maternal restriction of caloric intake examined the risk of binge-eating disorders over a 13-year period. The study concluded that witnessing or experiencing disordered eating behaviors in childhood correlated with binge eating of snacks; the binging occurred despite eating to satiety. [18]

Thorough history taking should include query regarding suicidal ideation or planning or self-harm. [19] It is critically important to ask about substance misuse because of the frequent comorbidity of substance-use disorders with binge-eating disorder, [20] and questionnaires such as the AUDIT-C can be very helpful. [21]

A childhood history of emotional abuse also is a risk factor for BED. [52]

The use of a screening questionnaire such as the WRAQ (weight-related abuse questionaire) as designed by Salwen and Hymowitz in 2015 appears to be reliable and helpful. [50]

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Physical Examination

The role of the primary care provider should be to oversee the medical workup and to rule out physical conditions that can cause or contribute to morbidity and prevent mortality in eating disorders. [22]

Referral to a specialized eating-disorders center can be helpful, especially a center that can perform certain procedures such as observing the binge eater eating in the context of the family, which is not feasible for a primary care provider to include as part of the evaluation. [23, 24]

Additional roles of the primary care provider include encouraging appropriate treatment of binge-eating disorder and determining if treatment can safely occur on an outpatient basis or if a higher level of care is needed. [22]

The use of questionnaires such as the SCOFF and PHQ-9 can be very helpful to rule in or out comorbid conditions such as mood disorders or eating disorders besides binge-eating disorder and to ensure that an appropriate level of care is recommended. [25, 26]

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Research Trends

Research trends include the study of autoantibodies against neuropeptides that are associated with psychological traits in eating disorders. [27] Specific anti-ghrelin immunoglobulins have been found to modulate ghrelin stability and its orexigenic effect and may be helpful in treatment. [28]

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Complications

Screening for suicidality is especially important in the setting of bariatric surgery. Predictive factors for suicidality found by Adamowicz, Salwen, Hymowitz and Vivian included depressive symptomatology and hopelessness, as well as hopelessness and mood disorder diagnosis. [53]

 

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