Understanding Eating Behavior in Binge-Eating Disorder

Binge-eating disorder is a syndrome that is relatively new to the official psychiatric diagnostic system, Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The hallmark feature of binge-eating disorder is binge eating, which involves eating an unusually large amount of food in a distinct period of time (that is, not grazing) and experiencing a feeling of loss of control over eating. There is no precise definition for what an unusually large amount of food is and loss of control over eating is determined simply how a person feels while they are eating. (Individuals with bulimia nervosa also binge eat, but, unlike those with binge-eating disorder, engage in inappropriate compensatory behavior, like self-induced vomiting, after binge eating.)

The DSM-5 criteria for binge-eating disorder require that episodes of binge eating occur at least once weekly over the last three months. People must also describe uncomfortable experiences linked to the binge eating, such as eating alone because of feeling embarrassed about the amount they eat or eating much more rapidly than normal. Binge-eating disorder affects approximately 1% of adults, and rates are higher in adults with obesity. Adults with binge-eating disorder commonly have symptoms of other emotional problems such as depression and anxiety.

Though this eating disorder was officially recognized as a psychiatric diagnosis in 2013, its basic elements were described by Albert Stunkard MD in 1959, and, in 1994, when DSM-IV – the predecessor of DSM-5 – was published, tentative criteria for binge-eating disorder were included in an appendix. (Binge-eating disorder was not included as an official diagnosis in the DSM-IV because there was not enough research about the characteristics of the disorder to support its inclusion.) As intended, the inclusion of draft criteria for binge-eating disorder criteria in DSM-IV generated research, and that research provided enough evidence to support the disorder’s official recognition in DSM-5. Yet, many fundamental questions about binge-eating disorder remain.

One of the most fundamental questions about binge-eating disorder is the relative significance of the feeling of loss of control over eating versus the size of the episode in binge eating. Research to date does tell us that the experience of loss of control over eating is linked to psychological distress, thus underscoring the clinical importance of this component of binge eating. With respect to size of binge-eating episodes, laboratory studies of eating behavior conducted at the Columbia Center for Eating Disorders found that people with this disorder eat significantly more calories when they binge eat or eat normally compared to those without binge-eating disorder. These data suggest that there is, in fact, something unusual about eating behavior in people with binge-eating disorder.

However, data on eating behavior collected outside of the laboratory is more confusing. Here are three puzzling findings:

1. People with binge-eating disorder report eating more calories than similar individuals without binge-eating disorder, yet energy expenditures of those with and without binge-eating disorder are nearly identical, suggesting individuals with binge-eating disorder may be more accurate reporters of caloric intake.
2. Assessment studies in which hand-held devices are used to ask people about binge eating and emotion in real-time show that adults with and without binge-eating disorder do not differ as much in eating behavior as in the psychological distress they experience about their eating.
3. When people with binge-eating disorder receive treatment, they do not generally lose weight. This is puzzling, given that weight loss would be expected when binge episodes cease.

Together, what these findings suggest is that the eating behavior of individuals with binge-eating disorder may not be so different from that of individuals without binge-eating disorder. The bigger distinguishing feature may be emotional distress. But more research is needed to confirm this. Such research could have important clinical implications for how binge-eating disorder is treated.

At Columbia, we are undertaking a new investigation to learn more about eating behavior in people with binge-eating disorder in their real-world settings. To do this, participants wear a device called the Automatic Ingestion Monitor (AIM), pictured here, that assesses food intake by taking pictures. Essentially, it takes a few pictures per minute whether or not someone is eating. The AIM device is small and is mounted onto the side of the participant’s glasses or to a pair of blue-light glasses; the AIM picks up chewing and turns on, allowing us to look at the pictures taken when someone is eating. While participants wear the AIM, they will also report on their sense of loss of control over eating and their mood using a smartphone.

Currently, we are seeking people with binge-eating disorder to volunteer. No in-person visits are required, and volunteers can earn as much as $500 for participating. If you are interested in learning more, please call (646) 774-8066 or email us at edru@nyspi.columbia.edu.

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