Binge eating disorder (BED) is the most common type of eating disorder in
the United States and appears to be far more prevalent than other eating
disorders such as anorexia and bulimia, according to the results of a large
According to the findings, 3.5 percent of women and 2 percent of men
reported experiencing symptoms of BED currently or at some point during their
lives. In contrast, 0.9 percent of women and 0.3 percent of men reported
symptoms of anorexia, and 1.5 percent of women and 0.5 of men reported
symptoms of bulimia.
The results appeared in the February 1 Biological Psychiatry.
"Previously, we didn't know the extent of the prevalence of binge
eating disorders," first author James Hudson, M.D., Sc.D., told
Psychiatric News. "We were surprised that it was more common
than both anorexia and bulimia combined."
Hudson is director of the psychiatric epidemiology research program at
McLean Hospital and a professor of psychiatry at Harvard Medical School.
The findings are based on data collected through the National Comorbidity
Survey Replication, a nationally representative sample of the U.S. population.
The household survey was conducted among more than 9,282 English-speaking
adults over age 18 on a face-to-face basis between February 2001 and December
Hudson and his colleagues completed an analysis on a randomly chosen
subsample consisting of 2,980 subjects and determined whether they had ever
experienced an eating disorder based on questions from the World Health
Organization Composite International Diagnostic Interview (CIDI).
Researchers used questions from the diagnostic interview to assign
diagnoses of anorexia nervosa, bulimia nervosa, or BED to subjects based on
DSM-IV criteria. Currently, the criteria for BED are listed in
Appendix B of the DSM-IV-TR under the heading "Criteria Sets
and Axes Provided for Further Study." The syndromes or conditions are
listed in this section pending further research that could provide scientific
evidence warranting the conditions' status as a formal disorder.
The only instance in which the survey diverged from DSM criteria
was for duration of symptoms classified under binge eating disorder—the
DSM-IV requires a minimum of six months of regular eating binges,
whereas the CIDI requires a minimum of three months of symptoms.
Hudson and his colleagues found that 2.8 percent men and women in the
sample reported current or past symptoms of BED, and smaller proportions
reported current or past symptoms of bulimia (1 percent) and anorexia (0.6
The mean number of years that subjects experienced symptoms of bulimia and
BED (8.3 and 8.1, respectively) was significantly higher than that of anorexia
Findings from prior studies often involved patients who had been
hospitalized or had severe forms of the disorder. Thus, said Hudson, "We
had long thought that anorexia was a persistent and chronic condition. These
findings suggest that there are people in the community who have it for
shorter periods of time, so it need not be a chronic and devastating
He also emphasized, however, that anorexia can be a "serious,
devastating, and fatal condition." By studying the factors associated
with a short duration of illness, he said, researchers may be able to learn
how to prevent more severe cases.
In addition, Hudson found that more than half (56.2 percent) of respondents
with anorexia, 94.5 percent of those with bulimia, and 78.9 percent of those
with BED met criteria for at least one other DSM-IV disorder,
including mood and anxiety disorders, impulse-control disorders, and substance
Half of those with anorexia (50 percent) and BED (51.2 percent) reported
receiving treatment for emotional problems at some time in their lives,
according to the findings. Slightly more than 63 percent with bulimia sought
help for an emotional problem at some point during their lives.
The majority of those with an eating disorder sought help in the general
Hudson also noted that those with BED were about five times more likely
than those without it to have a body mass index of 40 or higher.
Due to the relatively high prevalence of BED in comparison with other
eating disorders, the duration of the illness, and its association with
obesity, Hudson considers BED a major public health problem and one of the
factors underlying the obesity epidemic in the United States. He also said it
warrants inclusion in DSM-V, which is scheduled for release in
According to William Narrow, M.D., M.P.H., associate director of APA's
Division of Research, the DSM-V Eating Disorders Workgroup is
reviewing the literature on BED to determine whether it should be categorized
as a mental disorder in the DSM-V.
Hudson said that primary care doctors and other clinicians should become
aware of the symptoms for binge eating (see
box) to improve
recognition and treatment of BED. The symptoms of BED have the potential to be
reversed through cognitive-behavioral techniques or through use of certain
medications, he noted. Intervention could make a significant impact in the
obesity epidemic, he added.
The NCS-R is funded by the National Institute of Mental Health, National
Institute on Drug Abuse, Substance Abuse and Mental Health Services
Administration, Robert Wood Johnson Foundation, Eli Lilly and Co., and John W.
An abstract of "The Prevalence and Correlates of Eating
Disorders in the National Comorbidity Survey Replication" is posted at<www.journals.elsevierhealth.com/periodicals/bps/article/PIIS0006322306004744/abstract>.▪