To understand why emerging research about the diagnosis of binge eating disorder (BED) is increasingly being recognized in the psychiatric community, it is first critical to understand the behavioral phenomenon that is BED. Because of its close relationship to the better-understood (or at least more widely researched) condition of bulimia nervosa, it might be more effective for the purpose of an overview to describe how BED is distinguishable from bulimia. There appear to be notable differences that compel researchers to more thoroughly explore BED since it is closely linked to a pervasive issue in the US that doesn’t seem to be going anywhere anytime soon — obesity.

Though they examined slightly different diagnostic nuances, in recent years, research groups led by Striegel-Moore and Barry both compared women meeting criteria for purging bulimia nervosa and for BED. According to authors, data supports the view that BED is a disorder distinct from purging bulimia. Barry and colleagues found that there were some similarities between the groups (for example, body dissatisfaction) but that the significant differences noticed between women with bulimia and BED were associated with obesity status. Women with the BED were overwhelmingly found to be medically obese (having a body mass index of greater than thirty) compared with those women with bulimia. Also, bulimia sufferers scored higher on five personality disorder scales than BED patients.

Additionally distinguishing the two eating disorders involving binge-eating behaviors, a study was conducted comparing two community-based cohorts of young woman — one with bulimia and the other with BED — over a five-year period. At the five-year follow-up, the majority of women with BED had made a full recovery despite not having received any formalized treatment while results were much less promising for the group with bulimia. The study suggests an interestingly temporary component to BED.

The implications? To highlight a few: many statistically “normal” folks are affected by BED. In the US, the CDC reported in 2008 that 33.9% of adults age 20 years and over who are obese. In the general population, the prevalence of BED is between 1-3%. However, the prevalence of BED amongst obese individuals as well as in patients seeking help for weight loss is staggeringly greater (>25%). Therefore, the likelihood that those reading this article know someone meeting criteria for BED at some point in their life cycle is fairly great.

As for treatment, Charles Pull with the Department of Neuroscience at Luxembourg Hospital summarizes an in-depth examination of literature by suggesting that a combination of pharmacotherapy with psychotherapy is most efficacious in treating the disorder. He is clear, however, that more needs to be known to better determine appropriate treatment course.

If such a significant number of individuals in the US are touched by BED, that alone may be reason to better understand (and therefore further research) the disorder. What recent research is beginning to more firmly contribute regarding the previously less-understood of the eating disorders is that BED may largely be determined by genetic factors, racial and ethnic influences, and personality/character traits. If we continue to look at the factors that cause BED, along with effective ways to treat the disorder, we may well be on our way to addressing the elephant in the room in American culture –- obesity — in more substantive ways.

References

Barry DT, Grilo CM, & Masheb RM (2003). Comparison of patients with bulimia nervosa, obese patients with binge eating disorder, and nonobese patients with binge eating disorder. The Journal of nervous and mental disease, 191 (9), 589-94 PMID: 14504568

Brewerton T. Binge Eating Disorder: Recognition, Diagnosis, and Treatment. Medscape Psychiatry & Mental Health eJournal, 1997;2(3).

CDC. Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults: United States, Trends 1960–1962 Through 2007–2008. Division of Health and Nutrition Examination Surveys, 2010.

Pull CB. Binge Eating Disorder. Current Opinion in Psychiatry, 2004;17(1).

Striegel-Moore RH, & Franko DL (2003). Epidemiology of binge eating disorder. The International journal of eating disorders, 34 Suppl PMID: 12900983

Image via Amore / Shutterstock.

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The Itasca Brain and Behavior Association (IBBA), comprised of psychiatrists and researchers, conducted an in-depth examination of the relationship between the economic downturn in Japan and an increase in Japan’s suicide rate. At the 2011 American Psychiatric Association annual meeting, IBBA researchers discussed that similar trends in America may already be underway.

To caution of possible parallels in the United States, Dr. Yates, principle investigator on the IBBA team, shared what he learned from Dr. Maki Matsuki and other Japanese colleagues: In the late 1990s, when Japan experienced an economic slump that resulted in a doubling of the country’s unemployment rate, there began a concurrent, “persistent and significant increase” in suicide rates in Japan. After subsequent psychological autopsies, Japanese police teams concluded that a significant causative theme amongst those who committed suicide included unemployment and other significant financial stressors.

What might this important link between economic stressors and increased suicide rate in Japan mean for Americans? The economic conditions described above are not that dissimilar to the current economic climate in the United States. In 2009, there began a significant jump in America’s unemployment rate which has continued to decline over the last two years. Based on this and other economic data reviewed, Dr. Yates suggests that an increase in suicide similar to Japan’s could take place in the United States, occurring through 2012 and possibly extending up to 2016. Dr. Yates warned based on his findings, “If we had a similar increase in suicide rates [as Japan], it would be somewhere in the order of an additional 14,000 individuals per year.”

To further the case for increased consciousness on the topic, Falagas and colleagues reviewed eleven “all-cause” mortality studies spanning the duration of our current as well as two previous decades, and reaching across varying global populations. The studies examined why people die. In review of the literature — specifically, six studies that looked at transportation-related fatalities — Falagas and his team noted that in all six studies, suicide-related mortality increased in temporal association with the economic crisis of the period.

Dr. Yates on the Brain and Behavior team, however, is clear to make the point that although recent research suggests economic stressors for individuals plays at least some role in suicide outcomes, the presence of psychiatric illness and substance abuse issues remains the primary predicator of suicide risk.

Ultimately, these studies point to the need for awareness-raising. Why? Because mental illness, substance abuse and economic issues are not mutually exclusive; and, in fact, are arguably tightly linked. For example, those predisposed to mental illness and/or substance abuse issues also likely have difficulty securing and maintaining jobs in a climate with dramatically increased competition for said jobs. Perhaps even more critical is that those who are the most vulnerable to experiencing depression, substance abuse, and other mental health-related issues and diagnoses, are also the very individuals that do not have access (i.e. insurance) for the care they need that might interfere with seeking the permanent solution to a temporary problem… suicide. As global and domestic economic climates continue to present news of uncertainty, and as bleeding edge medical and psychiatric research relevant to these constantly-changing circumstances goes to print, the trickling effects on individuals across the world will beg further exploration.

References

Cassels, Caroline. Economic Woes and Suicide: Will the United States follow Japan? American Psychiatric Association (APA) 2011 Annual Meeting: Abstract NR04-71. Presented May 15, 2011.

Falagas ME, Vouloumanou EK, Mavros MN, & Karageorgopoulos DE (2009). Economic crises and mortality: a review of the literature. International journal of clinical practice, 63 (8), 1128-35 PMID: 19624782

Gresenz CR, Stockdale SE, & Wells KB (2000). Community effects on access to behavioral health care. Health services research, 35 (1 Pt 2), 293-306 PMID: 10778816

Image via Martin M303 / Shutterstock.

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