Download Binge Episodes
Amintor Robillard
In binge-eating disorder and bulimia nervosa, people experience recurrent and frequent episodes in which they eat unusually large amounts of food and feel a sense of loss of control. In bulimia nervosa, these binge-eating episodes are followed by behavior that compensates for the overeating, such as self-induced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors.
Having the ability to predict binge and purge episodes and intervene in real-time before they occur would support the development and scalability of treatments for binge-eating disorder and bulimia nervosa. A study funded by the National Institute of Mental Health (NIMH), spearheaded by Cynthia Bulik, Ph.D. , of the University of North Carolina, Chapel Hill, is aiming to do just that. Dr. Bulik and her research team are using an app, Recovery Record , which has been adapted for use on a smartwatch, to collect a massive amount of clinical, physiological, and behavioral information from people who have agreed to have their data recorded, which they hope will allow them to predict in real-time when binge and purge episodes are likely to occur.
The app will collect information about binge-eating, purging, nutrition, mood, cognition, autonomic nervous system (ANS) activity, actigraphy, and geolocation to help characterize the conditions under which individuals are more or less likely to binge or purge in their daily lives. The data will be collected over 30 days from more than 1,000 individuals with binge-eating disorder or bulimia nervosa. The analysis team, led by Jonathan Butner, Ph.D. , of the University of Utah, will then model the data to see if they can identify stable, low-risk, and high-risk patterns that signal impending binge or purge episodes.
Researchers and clinicians currently do not have the ability to predict binge and purge episodes with any level of reliability. If this NIMH-supported project is successful, it has the potential to lay the foundation for developing large-scale real-time treatment and prevention efforts in the area of eating disorders.
Objective binge eating episodes (OBEs) refer to binge eating on an unusually large amount of food and are the core symptom in current definitions of bulimia nervosa (BN) and binge eating disorder (BED). Subjective binge eating episodes (SBEs) refer to eating on a small or moderate amount of food (that is perceived as large) and like OBEs are associated with loss of control (LOC). Reaching consensus on what is considered a large amount of food can however be problematic and it remains unclear if the size of a binge is an essential component for defining a binge eating episode. The aim of this study was to compare the eating disorder features and general psychopathology of subjects reporting OBEs with those reporting only SBEs.
This is a retrospective secondary analysis of data from 70 obese participants at the recruitment phase of a multicentre trial for BED. Individuals who answered positively to the presence of binge eating and LOC over eating had their binge eating episodes further explored by interview and self-report. Two groups, those who reported current OBEs (with or without SBEs) and those who reported current SBEs only were compared for age, gender, marital status, body mass index (BMI), indicators of LOC over eating, severity of binge-eating and associated psychopathology.
The majority of participants in both the OBE and SBE groups endorsed the experience of at least four indicators of LOC. There were no significant differences between the groups. Both groups had high levels of binge-eating severity, moderate severity of associated depressive symptoms and frequent psychiatric co-morbidity.
Treatment seeking participants with obesity who reported SBEs alone were similar to those who reported OBEs in terms of eating disorder features and general psychopathology. These findings suggest that classificatory systems of mental illnesses should consider introducing SBEs as a feature of the diagnostic criteria for binge eating and, thus, facilitate the inclusion of participants with SBEs in treatment trials.
Binge eating is currently defined as a discrete episode of overeating of an objectively large amount of food associated with a feeling of loss of control (LOC). It is the core symptom of bulimia nervosa (BN) and binge eating disorder (BED) and it can be present in purging-type anorexia nervosa (AN) [1]. In addition, three of a set of five criteria that are markers of LOC are required for the definition of an objective binge eating episode (OBE) in the diagnosis of BED in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revised (DSM-IV-TR) [1]. The subjective binge eating episode (SBE) is defined where LOC is also experienced but the amount of food consumed is small or moderate, although perceived as large [2].
The aim of this study was thus to examine whether participants with overeating and co-morbid obesity reporting SBEs alone or OBEs (with or without SBEs) differ in terms of sociodemographics and clinical characteristics including BMI, severity of binge eating, presence of markers of LOC and associated general psychopathology. Our specific hypothesis was that there would be no difference in the endorsement of diagnostic criteria for markers of LOC.
Eighty seven people who reported recurrent binge eating in the screening phase in our site completed this additional questionnaire where a more detailed description of the binges was asked. From these participants, 17 were excluded from this sample for the following reasons: 12 (13.8%) could not give accurate and reliable descriptions of binges, 1 (1.1%) had incomplete data at SCID-I/P and 4 (4.6%) did not meet criteria for sense of LOC over eating (negative answer to item A2 of BN module) and/or periodicity (negative answer to item D of BED module) in the SCID-I/P. The seventy remaining (80.4%) were included in this study.
This interview aimed at collecting a more detailed description of typical episodes of binge eating for the individual. It consists of a first question investigating the date, the occasion (routine or special situation), the hour, the place, with whom and a detailed description of a typical binge eating episode. If this first description did not include an OBE, a second question asked about any other binge eating episode larger than the first one with the same topics mentioned above.
This reliable and valid structured interview for psychiatric diagnoses according to the DSM-IV was employed for the BED diagnoses and evaluation of the presence of recurrent episodes of eating a large amount of food when feeling out of control over eating [29].
Participants were categorized in two groups: those who described a typical binge eating episode that involved an actual large amount of food (OBE group, n = 56), and those who described the typical binge eating episode as a binge that involved an amount of food perceived as large by the subject - but not considered large by the examiners - and who denied ever having experienced larger episodes (SBE group, n = 14).
Interestingly, our BMI findings support a similar impact of both OBEs and SBEs on body weight, as both groups showed mean weights in the moderate severity level of obesity. In a BN study, there were no differences between the type of binge and the BMI measures [10]. Different findings were found in another study with participants with bulimic-type ED, in which the OBE group had a higher weight than SBE group [5]. A study with bariatric surgery candidates showed a higher mean BMI in the OBE group compared to the SBE group, which was also higher than the non binge-eating group; however the authors found that despite the absence of large amounts of food eaten, individuals with SBEs were at risk of obesity and weight gain, although the mechanism was not clear [25].
2) (If the description of the episode provided does not include an objectively large amount of food). Are there other episodes when you eat an amount of food that is larger than then the previously described? ( ) Yes ( ) No Please, describe one of these episodes.
Most people who binge drink are not dependent on alcohol.3 However, binge drinking is harmful on its own. It is associated with serious injuries and diseases, as well as with a higher risk of alcohol use disorder.3
Binge eating disorder (BED) is an eating disorder characterized by frequent and recurrent binge eating episodes with associated negative psychological and social problems, but without the compensatory behaviors common to bulimia nervosa, OSFED, or the binge-purge subtype of anorexia nervosa.
BED is a recently described condition,[8] which was required to distinguish binge eating similar to that seen in bulimia nervosa but without characteristic purging. Individuals who are diagnosed with bulimia nervosa and binge eating disorder exhibit similar patterns of compulsive overeating, neurobiological features of dysfunctional cognitive control and food addiction, and biological and environmental risk factors.[9] Some professionals consider BED to be a milder form of bulimia with the two conditions on the same spectrum.[10]
Binge eating is the core symptom of BED; however, not everyone who binge eats has BED.[12] An individual may occasionally binge eat without experiencing many of the negative physical, psychological, or social effects of BED. This may be considered disordered eating rather than a clinical disorder. Precisely defining binge eating can be problematic,[8] however, binge eating episodes in BED are generally described as having the following potential features:
In contrast to bulimia nervosa, binge eating episodes are not regularly followed by activities intended to compensate for the amount of food consumed,[8] such as self-induced vomiting, laxative or enema misuse, or strenuous exercise.[15] BED is characterized more by overeating than dietary restriction.[17] Those with BED often have poor body image and frequently diet, but are unsuccessful due to the severity of their binge eating.[17]
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