B i n g e E a t i n g D i s o rd e r

Anna I. Guerdjikova, PhD, LISWa,b,*, Nicole Mori, RN, MSN, APRN-BCa,b,

Leah S. Casuto, MDa,b, Susan L. McElroy, MDa,b

KEYWORDS
 Binge eating disorder  Female binge eating  Treatment  Gender  Sex differences
 Eating dysregulation

KEY POINTS
 Binge eating disorder is more prevalent than anorexia nervosa and bulimia nervosa com-
bined and it is the most common eating disorder in males.
 Binge eating disorder remains underrecognized and undertreated in both sexes.
 Males and females with binge eating disorder are more similar than different in their pre-
sentation and treatment response.
 Binge eating disorder is a treatable illness and psychological and pharmacologic treat-
ments are now available.

BINGE EATING DISORDER

Binge eating disorder (BED) is the most common eating disorder (ED) and an impor-
tant public health problem worldwide. Recent data from the World Health Organiza-
tion Mental Survey Study, which surveyed adults from 14 countries on 4 continents,
found a lifetime prevalence rate of BED to be 1.4%.1 In the United States, the

Conflict of Interest: Dr L.S. Casuto and Mrs N. Mori have no conflicts of interest to disclose. Dr S.
L. McElroy is a consultant to or member of the scientific advisory boards of Bracket, F.
Hoffmann-La Roche Ltd, MedAvante, Myriad, Naurex, Novo Nordisk, Shire, and Sunovion.
She is a principal or coinvestigator on studies sponsored by the Alkermes, Forest, Marriott
Foundation, National Institute of Mental Health, Naurex, Orexigen Therapeutics, Inc, Shire,
Sunovion, and Takeda Pharmaceutical Company Ltd. She is also an inventor on US Patent
No. 6,323,236 B2, use of sulfamate derivatives for treating impulse control disorders, and
along with the patent’s assignee, University of Cincinnati, Cincinnati, Ohio, has received pay-
ments from Johnson & Johnson, which has exclusive rights under the patent. Dr A.I. Guerdji-
kova is employed by the University of Cincinnati College of Medicine and is a consultant for
Bracket.
a
Lindner Center of HOPE, 4075 Old Western Row Road, Mason, OH 45040, USA; b Department
of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincin-
nati, OH, USA
* Corresponding author. Department of Psychiatry and Behavioral Neuroscience, Lindner Cen-
ter of HOPE, University of Cincinnati College of Medicine, 4075 Old Western Row Road, Mason,
OH 45040.
E-mail address: anna.guerdjikova@lindnercenter.org

Psychiatr Clin N Am - (2017) -–-

http://dx.doi.org/10.1016/j.psc.2017.01.003 psych.theclinics.com
0193-953X/17/ª 2017 Elsevier Inc. All rights reserved.
2 Guerdjikova et al

lifetime prevalence of BED has been estimated to be 2.6%; BED continues to

be an underrecognized and undertreated condition. Patients rarely spontaneously
disclose binge-eating symptoms because of embarrassment or shame. Binge-
eating behavior is overlooked, and treatment commonly focuses on obesity and
its complications as the presenting problem rather than addressing the core eating
psychopathology.
BED is characterized by recurrent episodes of binge eating, defined as eating in a
discrete period of time (about 2 hours) an amount of food larger than most people
would eat under similar circumstances and having a sense of loss of control over
the eating. Additionally, patients do not engage in the inappropriate compensatory
behaviors of bulimia nervosa (BN), for example, self-induced vomiting or excessive
use of diuretic or laxatives. Binge-eating episodes are associated with feelings of
guilt and distress and occur on average at least once a week for 3 consecutive
months. During a binge-eating episode, patients might eat large amounts of food
when not feeling physically hungry, eat more rapidly than normal, and eat until feeling
uncomfortably full. Patients with BED often eat in secrecy; they are embarrassed by
the binge-eating behavior and their perceived inability to control the urges to
overeat.2

HISTORICAL OVERVIEW OF BINGE EATING DISORDER AND OTHER EATING DISORDERS

Anorexia nervosa (AN), BN, and BED are the 3 major types of EDs outlined in Diag-
nostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).2 AN is charac-
terized by intense fear of gaining weight or becoming fat resulting in persistent
restriction of food intake leading to significantly low body weight. Individuals with
BN engage in recurrent binge-eating behaviors followed by inappropriate compensa-
tory weight-loss behaviors, such as self-induced vomiting or abuse of laxatives or di-
uretics. BED is characterized by recurrent episodes of binge eating that are not
followed by the inappropriate weight loss behaviors diagnostic for BN. The estimated
lifetime prevalence of DSM-IV AN, BN, and BED is 0.9%, 1.5%, and 3.5% among
women and 0.3% 0.5%, and 2.0% among men, respectively3; thus, BED is more com-
mon than AN and BN combined. All FDs are highly heritable illnesses4 and associated
with decreased quality of life and increased disability, morbidity, and mortality.1,5
Medical cases describing symptoms of AN appeared in literature in the early seven-
teenth century with the work of the English physician Dr Morton. Binging with subse-
quent purging were both known through ancient history with the Hebrew Talmud
(AD 400–500) referring to a ravenous hunger that should be treated with sweet foods
(boolmot), but the medical term bulimia nervosa was not introduced until 1979 and
then included as a formal diagnosis in DSM-III in 1987. BED was first formally
described in 1959 by Albert Stunkard6 as a form of abnormal eating among obese pa-
tients. In his seminal article “Eating Patterns and Obesity,” he described a female pa-
tient with binge eating as follows: “She usually began to feel a desire for food in the
early evening, and would eat a large supper. Only temporarily sated, she soon
returned to the kitchen and consumed larger and larger amounts of food at progres-
sively shorter intervals. During these hours, she was assailed by loneliness and anxi-
ety. She rarely fell asleep before midnight, and usually awoke within an hour, anxious
and hungry. Then she would eat a pint of ice cream and drink a bottle of soda pop.”6
Overall, all 3 types of EDs received little systematic attention until the middle of the
twentieth century when they were conceptualized as mental illnesses and included in
formal disease classifications. As recently as 2013, BED was added to DSM-5 as a
stand-alone psychiatric disorder.
 Binge Eating Disorder 3

OVERVIEW OF PSYCHIATRIC AND MEDICAL COMORBIDITIES OF BINGE EATING

DISORDER

BED co-occurs with a plethora of psychiatric disorders, most commonly mood and
anxiety disorders. Data from 9282 participants in the National Comorbidity Survey
demonstrated that approximately 4 out of 5 adults with lifetime BED have at least
one comorbid psychiatric disorder, and approximately 1 out of 2 adults with BED
has 3 or more comorbid psychiatric disorders.3 Consistently, in a study of 404 patients
with BED, 73.8% had at least one additional lifetime psychiatric disorder and 43.1%
had at least one current psychiatric disorder.7 Mood (54.2%), anxiety (37.1%), and
substance use (24.8%) disorders were the most common psychiatric disorders among
patients with BED. Of interest, in a recent study among 11,588 adult men and women
presenting to ED treatment clinics in Sweden, the highest levels of psychiatric comor-
bidity were among women with BED as compared with women with AN and BN,
particularly regarding anxiety (55%) and mood (45%) disorders.8
Obesity and its complications are among the medical comorbidities most
commonly associated with BED. Growing evidence suggests that BED may indepen-
dently increase the risk of development of certain components of metabolic syn-
drome, like diabetes, hypertension, and dyslipidemia, over and above the risk
attributable to obesity alone.9 Other medical disorders or problems with BED include
pain condition, sleep disorders and sleep problems, fibromyalgia, and irritable bowel
syndrome.10 Preliminary data indicate that the cardiovascular system, reproductive
system, and cortisol response might also be affected in patients with BED.11

BINGE EATING DISORDER IN WOMEN VERSUS BINGE EATING DISORDER IN MEN

In contrast to AN and BN, which occur in a 9:1 female to male ratio, the female to male
ratio is more balanced in BED, about 6:4.3 Sex disparities in EDs have been hypoth-
esized to be due to the interplay between biological differences between women
and men and to the differential influence of sociocultural factors on the sexes. Among
biological differences, the organizational effect of estrogens during puberty is thought
to facilitate the development of BEDs in genetically vulnerable females.12 Binge eating
frequency and dysfunctional eating symptoms are higher during the luteal phase of the
menstrual cycle; correlations between estradiol and progesterone levels and disor-
dered eating were demonstrated across levels of dietary restraint, levels of impulsivity,
and patients’ body mass index (BMI).13 From a sociocultural perspective, overvalua-
tion of the “thin ideal” and increased exposure to dieting and peer pressure might pref-
erentially increase the risk for EDs in females.14
Five studies have compared the features of males and females with BED in clinical
samples.15–19 Interestingly, males and females with BED consistently seem to be more
similar than different in their presentations. In the first study, baseline characteristics of
21 men and 21 age-matched women with BED were compared using the Eating Dis-
orders Examination (EDE), the Structured Clinical Interview for DSM-III-R (SCID), and
SCID II for personality disorder assessments.15 Men and women did not differ on mea-
sures of eating disturbance, shape and weight concerns, interpersonal problems, or
self-esteem. Although women were more likely to report eating in response to negative
emotions, particularly anger, frustration, and anxiety, more men met criteria for at least
one axis I diagnosis and had a lifetime diagnosis of substance dependence. In the sec-
ond study, 35 men and 147 women who were consecutively evaluated for outpatient
clinical trials in BED were administered a battery of measures to examine develop-
mental, eating and weight-related disturbances, and psychological features associ-
ated with BED.17 Men and women did not differ significantly on developmental
4 Guerdjikova et al

variables or on measures of current ED features, like binge-eating behaviors or weight

or shape concerns. However, higher body dissatisfaction, drive for thinness, dietary
restraint, and emotional eating were significantly more prevalent among women. In
the third study, 44 obese men with BED were compared with 44 age- and race-
matched obese women with BED seeking weight-loss treatment.16 Obese men with
BED had attempted significantly fewer diets and used fewer medications and supple-
ments for weight loss, but the two sexes did not differ significantly in ages of onset of
BED or obesity, current BMI, number of binge-eating episodes at presentation for
treatment, or presence or severity of mood disorder symptoms. In the fourth study,
198 obese adults (26% men) were recruited in primary care settings for a treatment
study for obesity and BED.18 Women reported significantly earlier age at onset of over-
weight and dieting and greater frequency of dieting, and men engaged in more
frequent strenuous exercise. Men were also more likely than women to meet criteria
for metabolic syndrome. However, women and men did not differ on onset for either
overweight or binge eating or in features of EDs, emotional eating scores, perceived
stress, depressive symptoms, or self-control. In the fifth study, data were pooled
from 408 women and 54 men who were participants in pharmacotherapy trials for
BED.19 Men and women with BED who enrolled in pharmacotherapy studies were
similar on most variables, including age of onset of BED and severity of BED symp-
toms. However, men were older at study entry, had lower levels of depressive symp-
toms, and had a greater frequency of lifetime alcohol use disorders. Additionally, men
had significantly higher BMIs, significantly higher systolic and diastolic blood pres-
sures, and were taking more prescription medications for diabetes and dyslipidemia.
The few studies that have examined sex differences in BED treatment outcome have
not found significant differences.16,19–22 Of interest, a recent study aggregated data
from 11 randomized controlled psychosocial BED treatment studies and examined
differences between 208 men and 1117 women. Baseline and outcome symptoms
were assessed via the interview and questionnaire versions of the EDE. Men and
women reported similar levels of dietary restraint and binge-eating episode fre-
quencies at baseline. Men reported significantly lower shape, weight, and eating con-
cerns as well as lower global EDE scores than women. After treatment, men and
women did not differ significantly on global EDE score, number of binge-eating epi-
sodes in the past 28 days, remission of binge eating, or premature study dropout.23
Similarly, in the review of 9 double-blind, placebo-controlled, randomized trials and
2 open-label trials examining various medications for BED, of 88 participants receiving
an antidepressant, 66% of the women and 88% the men were responders. Of the 80
participants receiving an antiepileptic medication, 74% of women and 80% of men
were responders with no significant differences between the two sexes.19 In sum,
limited available data suggest women and men with BED are more similar than
different in their presentation and response to psychological and pharmacologic
treatments.

NEUROBIOLOGY OF BINGE EATING DISORDER IN WOMEN

Sex differences in eating behavior have been the subject of physiologic research over
the last century since the initial observations that the removal of the ovaries leads to
accumulation of adipose tissue and that food intake varies through the ovarian cycle
in intact female rats. Appetite and satiety variations across the menstrual cycle have
been documented in women.24,25 Additionally, there are sex differences in sensory
and flavor hedonic responses.26,27 These differences in eating are thought to be medi-
ated by a complex network including cholecystokinin, glucagonlike peptide-1,
 Binge Eating Disorder 5

glucagon, insulin, amylin, apolipoprotein, and leptin orchestrated by the central neuro-
chemical signaling via serotonin and glutamate and numerous neuropeptides.13
Study of the neurobiology of BED in humans is in its infancy. For example, females
with BED have shown greater cognitive attentional biases toward food; decreased
reward sensitivities; cognitive deficits in attention, executive function inhibitory con-
trol, and decision making; and altered brain activation in regions associated with
impulsivity and.28 Right-insular cortex activation differentiates women with BED
from obese and normal-weight non-BED women.29 Neurophysiologic and neuroimag-
ing studies comparing obese women with BED with non-BED obese women
suggested that altered function in cortical and striatal brain regions possibly contrib-
utes to BED. For example, increased centroparietal cortical long-latency event-related
potentials when viewing high-caloric food30 and increased regional cerebral blood
flow in left frontal and prefrontal cortices in response to food stimuli31 have been
observed in obese females with BED compared with similarly obese females
without BED.
Although most studies of BED neurobiology have been done in females, the effects
of ovarian hormones on eating behavior and weight regulation have not been empiri-
cally determined. Ovarian hormones might exhibit a genomic effect within the central
nervous system as they act as gene transcription factors in several neurobiological
systems that are known to be related to deregulated eating behavior.32 High levels
of progesterone and low levels of estradiol were reported to be associated with
increased binge eating and emotional eating in a nonclinical sample of 19 healthy
women33 and in women with BN.34 Furthermore, estradiol and progesterone interac-
tion might predict within-person changes in emotional eating, independent of negative
effect and BMI.35 Work by the same group also demonstrated that low estradiol and
low progesterone were associated with greater dysregulated eating in women with
objective binge-eating episodes, in addition to the high estradiol and high progester-
one risk milieu.36

MEDICAL COMORBIDITY OF BINGE EATING DISORDER IN WOMEN

It is well established that BED is associated with obesity.3 Moreover, binge-eating

behavior is prospectively associated with the development of obesity.37,38
The authors were able to locate 6 cross-sectional studies of various medical condi-
tions in women with BED, and they are summarized in Table 1. Among women, BED is
associated with early menarche, menstrual dysfunction, delivery of higher-birth-
weight babies, and long duration of the first and second stages of labor.39–42
Conversely, certain endocrine conditions in women might be associated with BED.
Among 215 women with type 2 diabetes, 13.5% had DSM-IV BED and binge eating
predicted blood glucose control after controlling for BMI and exercise level.43 In
another study, women with type 2 diabetes and BED had a significantly higher BMI
and A1C levels than diabetic controls without BED.44 Among 103 women with polycy-
stic ovary syndrome, 13% had BED compared with 2% of controls.45 Finally, meta-
bolic syndrome has been reported to be more common in men with BED than
women with BED46,47; but this finding is inconsistent.16,48

TREATMENT OF BINGE EATING DISORDER IN WOMEN

BED remains underrecognized and undertreated. Primary care doctors are often un-
aware of the disorder. A decade old survey of physicians reported that more than
40% had never assessed their patients for BED.49 Only one-third of patients with
BED and BN had been asked about problems with eating by their primary care or other

Table 1
Cross-sectional studies of medical conditions in women with binge eating disorder
Study Participants
Johnson et al,42 2001 4651 Female patients
Bulik et al,60 2002 166 Caucasian obese
female twins
Trace et al,61 2012 Population-base sample of
3790 female Swedish twins
Algars et al,39 2014 11,503 Swedish female twins
Linna et al,40 2014 2257 Female patients with ED
Rosenbaum et al,62 2016 484 Female primary care
patients
Abbreviations: BE, binge eating behavior; DM, diabetes.
Assessments
Patient Health Questionnaire
and General Health Survey
Symptom checklist
Questionnaire about sleep
habits
Evaluation for menstrual
dysfunctions
Registry on pregnancy, obstetric,
and perinatal health
Patient Health Questionnaire
and review of medical history
6
Guerdjikova et al
Findings
Women with BED were significantly more likely to have
diabetes. BED was also associated with increased
prevalence of menstrual problems, shortness of
breath, chest pain, limb or joint pain, headaches,
and gastrointestinal problems,
BE was not associated with hypertension, visual impairment,
asthma/respiratory illness, DM, cardiac problems,
osteoarthritis, or any major medical disorder as compared
with no BE.
Lifetime BE was significantly associated with not getting
enough sleep. The associations between BE and sleep
remained after accounting for obesity.
BE, but not BED, was significantly associated with lifetime
oligomenorrhea and amenorrhea.
Women with BED had babies with higher birth weight,
and maternal BED was associated with hypertension.
Women with BED had significantly higher rates of chronic
pain, lipid disorders, hypertension, and sleep disorders.
 Binge Eating Disorder 7

health care professional,50 and less than 10% of respondents with BED received treat-
ment of their ED within the last year.1
A variety of clinician-administered or self-report tools to aid diagnosing of BED have
been recently developed. For example, a validated self-report screening instrument
for BED has been developed by Shire Inc (Binge Eating Disorder Screener-7) and is
available free of charge on their BED educational portal. Other instruments that can
be used for BED screening and diagnosis include Binge Eating Scale51 and the Eating
Disorder Examination-Questionnaire.52 Several government institutions and not-for-
profit organizations offer support to patients with BED and provide resources for
health care professionals. A comprehensive list of resources for professionals and pa-
tients is listed in Table 2.
Psychotherapy alone or in combination with self-help tools can be considered the
first line of treatment, especially if BED signs and symptoms are mild and there are
no clinically significant psychiatric comorbidities.53 It is recommended that all patients
seeking treatment of BED should receive psychoeducation.54 Cognitive behavior psy-
chotherapy (CBT), interpersonal therapy, and to a lesser degree dialectical behavior
therapy are the specific psychotherapies that have been effective for reducing
binge-eating symptoms and associated psychopathology. Their psychotherapies
are not effective, however, for weight loss in these patients.55 A basic feature of
CBT is developing awareness of one’s eating behaviors by daily monitoring and
recording of problematic behaviors. Numerous applications for mobile devices have
been developed in the recent years as self-help tools or to enhance treatment
of EDs.56
In moderate and severe BED cases, pharmacotherapy can be considered as
monotherapy or in conjunction with psychological interventions. Various classes of
medications, including antidepressants, antiepileptic drugs, antiobesity drugs, and
medications approved for attention-deficit/hyperactivity disorder (ADHD), have been
tested in randomized placebo-controlled trials in BED and found helpful in improving
binge-eating behavior and eating-related psychopathology.55 The only medication
that has regulatory approval for treatment of BED is lisdexamfetamine dimesylate
(LDX). LDX is specifically approved for treatment of adults with moderate to severe
BED. This approval was based on 3 randomized placebo-controlled studies in acute
adult BED: an 11-week phase II proof-of-concept study and 2 identically designed 12-
week phase III trials enrolling a total of 1044 patients. LDX dosed at 50 mg or 70 mg
(but not 30 mg) significantly reduced binge-eating symptoms, obsessive-compulsive
features of binge eating, and other measures of EDs psychopathology. Adverse reac-
tions reported by 3% or more of adult patients with ADHD taking LDX and at least
twice the incidence compared with patients taking placebo included decreased appe-
tite, insomnia, dry mouth, diarrhea, nausea, anxiety, anorexia, feeling jittery, agitation,
increased blood pressure, hyperhidrosis, restlessness and decrease weight. In the
United States, the Drug Enforcement Administration categorizes LDX as a schedule
II medication; thus, risk of abuse and dependence requires close monitoring. More-
over, although LDX was associated with weight loss in the 3 clinical trials, it is not
approved for weight loss or treatment of obesity.
As already reviewed, BED is often comorbid with other psychiatric conditions. Fe-
males, in particular, often present for treatment with nonspecific mixed symptoms
of chronic low mood, general anxiety, consistent weight gain or a pattern of yo-yo diet-
ing, sleep disturbances, poor concentration, and anhedonia. Carefully diagnosing po-
tential mood disorders and treating them accordingly is of paramount importance in
the management of BED. Women with a mood disorder and a co-occurring BED
commonly present with multidimensional problems that often cannot be treated
 8
Guerdjikova et al
Table 2
Resources for professionals and patients

Resource Web Site/Portal Resource Helpful for

Academy for Eating Disorders (AED) http://www.aedweb.org/ Clinicians
National Institute of Diabetes and Digestive https://www.niddk.nih.gov/health-information/ Clinicians
and Kidney Diseases (NIDDK)
International Journal for Eating Disorders http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1098-108X Clinicians
National Eating Disorders Collaboration http://nedc.com.au/about-the-nedc Clinicians and patients
WebMD http://www.webmd.com/ Clinicians and patients
Understanding Binge Eating http://www.bingeeatingdisorder.com/ Clinicians and patients
Binge Eating Disorder Association (BEDA) http://bedaonline.com/ Clinicians and patients
National Eating Disorder Association (NEDA) http://www.nationaleatingdisorders.org/ Clinicians and patients
Mobile Device Appsa Recovery Record (iPhone) Clinicians and patients
Rise Up (Android)

Abbreviation: apps, applications.

a
The two applications (apps) listed are the most downloaded and widely used.56 There are more than 50 apps available with an ED focus and 10 or more
specifically designed for BED. For a comprehensive list, please refer to “Apps and eating disorders: A systematic clinical appraisal.”56
 Binge Eating Disorder 9

with a single intervention and benefit from a team approach to management to opti-
mize outcomes. Ideally, a team of professionals, including a psychiatrist, a dietician,
and a therapist, would be available to provide support for patients and their families.
In regard to medical comorbidity, patients diagnosed with BED should receive
comprehensive medical evaluations with particular focus on diabetes, hypertension,
dyslipidemias, pain, sleep disorders, functional gastrointestinal disorders, and
asthma; women should additionally receive evaluation of reproductive function and
for polycystic ovary syndrome.
Finally, bariatric surgery has been shown to be effective for the treatment of severe
obesity; a notable proportion of bariatric surgery candidates had loss-of-control eating
or BED.57 Among bariatric surgery candidates, there were no differences in BED rates
or binge eating between women and men58 and weight loss and metabolic outcomes
after bariatric surgery were of similar magnitude in both sexes.59

SUMMARY

In summary, BED is the most prevalent ED but it continues to be underrecognized and

undertreated. BED is more common in females than in males but to a lesser degree
than AN and BN. Presentation and response to treatment of BED in females and males
is more similar than dissimilar, but this area requires further study. Neurochemical cor-
relates of EDs in general, and of BED in particular, are a growing field of basic and clin-
ical research that will help elucidate the biological substrate in those disorders and
further guide treatment. Recent validation of BED as a stand-alone diagnosis in
DSM-5 and approval of the first medication for its treatment mark the beginning of
a new era in the comprehensive management of BED.

REFERENCES

1. Kessler RC, Berglund PA, Chiu WT, et al. The prevalence and correlates of binge
eating disorder in the World Health Organization World Mental Health Surveys.
Biol Psychiatry 2013;73(9):904–14.
2. American Psychiatric Association. Diagnostic and statistical manual of mental
disorders. 5th edition. Arlington (VA): American Psychiatric Publishing; 2013.
p. 2013.
3. Hudson JI, Hiripi E, Pope HG Jr, et al. The prevalence and correlates of eating
disorders in the National Comorbidity Survey Replication. Biol Psychiatry 2007;
61(3):348–58.
4. Tozzi F, Bulik CM. Candidate genes in eating disorders. Curr Drug Targets CNS
Neurol Disord 2003;2(1):31–9.
5. Fichter MM, Quadflieg N. Mortality in eating disorders - results of a large pro-
spective clinical longitudinal study. Int J Eat Disord 2016;49(4):391–401.
6. Stunkard AJ. Eating patterns and obesity. Psychiatr Q 1959;33:284–95.
7. Grilo CM, White MA, Masheb RM. DSM-IV psychiatric disorder comorbidity and
its correlates in binge eating disorder. Int J Eat Disord 2009;42(3):228–34.
8. Ulfvebrand S, Birgegard A, Norring C, et al. Psychiatric comorbidity in women
and men with eating disorders results from a large clinical database. Psychiatry
Res 2015;230(2):294–9.
9. Hudson JI, Lalonde JK, Coit CE, et al. Longitudinal study of the diagnosis of com-
ponents of the metabolic syndrome in individuals with binge-eating disorder. Am
J Clin Nutr 2010;91(6):1568–73.
10. Olguin P, Fuentes M, Gabler G, et al. Medical comorbidity of binge eating disor-
der. Eat Weight Disord 2016. [Epub ahead of print].
10 Guerdjikova et al

11. Mitchell JE. Medical comorbidity and medical complications associated with
binge-eating disorder. Int J Eat Disord 2016;49(3):319–23.
12. Culbert KM, Racine SE, Klump KL. The influence of gender and puberty on the
heritability of disordered eating symptoms. Curr Top Behav Neurosci 2011;6:
177–85.
13. Asarian L, Geary N. Sex differences in the physiology of eating. Am J Physiol
Regul Integr Comp Physiol 2013;305(11):R1215–67.
14. Urquhart CS, Mihalynuk TV. Disordered eating in women: implications for the
obesity pandemic. Can J Diet Pract Res 2011;72(1):e115–25.
15. Tanofsky MB, Wilfley DE, Spurrell EB, et al. Comparison of men and women with
binge eating disorder. Int J Eat Disord 1997;21(1):49–54.
16. Guerdjikova AI, McElroy SL, Kotwal R, et al. Comparison of obese men and
women with binge eating disorder seeking weight management. Eat Weight Dis-
ord 2007;12(1):e19–23.
17. Barry DT, Grilo CM, Masheb RM. Gender differences in patients with binge eating
disorder. Int J Eat Disord 2002;31(1):63–70.
18. Udo T, McKee SA, White MA, et al. Sex differences in biopsychosocial correlates
of binge eating disorder: a study of treatment-seeking obese adults in primary
care setting. Gen Hosp Psychiatry 2013;35(6):587–91.
19. Guerdjikova A, Blom TJ, Mori N, et al. Gender differences in binge eating disor-
der: a pooled analysis of eleven pharmacotherapy trials from one research group.
J Mens Health 2014;11(4):183–8.
20. Munsch S, Biedert E, Meyer A, et al. A randomized comparison of cognitive
behavioral therapy and behavioral weight loss treatment for overweight individ-
uals with binge eating disorder. Int J Eat Disord 2007;40(2):102–13.
21. Safer DL, Robinson AH, Jo B. Outcome from a randomized controlled trial of
group therapy for binge eating disorder: comparing dialectical behavior therapy
adapted for binge eating to an active comparison group therapy. Behav Ther
2010;41(1):106–20.
22. Ricca V, Castellini G, Mannucci E, et al. Comparison of individual and group
cognitive behavioral therapy for binge eating disorder. A randomized, three-
year follow-up study. Appetite 2010;55(3):656–65.
23. Shingleton RM, Thompson-Brenner H, Thompson DR, et al. Gender differences in
clinical trials of binge eating disorder: an analysis of aggregated data. J Consult
Clin Psychol 2015;83(2):382–6.
24. Pohle-Krauza RJ, Carey KH, Pelkman CL. Dietary restraint and menstrual cycle
phase modulated L-phenylalanine-induced satiety. Physiol Behav 2008;93(4–5):
851–61.
25. Geiker NR, Ritz C, Pedersen SD, et al. A weight-loss program adapted to the
menstrual cycle increases weight loss in healthy, overweight, premenopausal
women: a 6-mo randomized controlled trial. Am J Clin Nutr 2016;104(1):15–20.
26. Hayes JE, Duffy VB. Oral sensory phenotype identifies level of sugar and fat
required for maximal liking. Physiol Behav 2008;95(1–2):77–87.
27. Drewnowski A, Kurth C, Holden-Wiltse J, et al. Food preferences in human
obesity: carbohydrates versus fats. Appetite 1992;18(3):207–21.
28. Kessler RM, Hutson PH, Herman BK, et al. The neurobiological basis of binge-
eating disorder. Neurosci Biobehav Rev 2016;63:223–38.
29. Weygandt M, Schaefer A, Schienle A, et al. Diagnosing different binge-eating dis-
orders based on reward-related brain activation patterns. Hum Brain Mapp 2012;
33(9):2135–46.
 Binge Eating Disorder 11

30. Svaldi J, Tuschen-Caffier B, Peyk P, et al. Information processing of food pictures

in binge eating disorder. Appetite 2010;55(3):685–94.
31. Karhunen LJ, Vanninen EJ, Kuikka JT, et al. Regional cerebral blood flow during
exposure to food in obese binge eating women. Psychiatry Res 2000;99(1):
29–42.
32. Ostlund H, Keller E, Hurd YL. Estrogen receptor gene expression in relation to
neuropsychiatric disorders. Ann N Y Acad Sci 2003;1007:54–63.
33. Klump KL, Keel PK, Culbert KM, et al. Ovarian hormones and binge eating:
exploring associations in community samples. Psychol Med 2008;38(12):
1749–57.
34. Edler C, Lipson SF, Keel PK. Ovarian hormones and binge eating in bulimia nerv-
osa. Psychol Med 2007;37(1):131–41.
35. Klump KL, Keel PK, Racine SE, et al. The interactive effects of estrogen and pro-
gesterone on changes in emotional eating across the menstrual cycle. J Abnorm
Psychol 2013;122(1):131–7.
36. Klump KL, Racine SE, Hildebrandt B, et al. Ovarian hormone influences on dys-
regulated eating: a comparison of associations in women with versus without
binge episodes. Clin Psychol Sci 2014;2(4):545–59.
37. Sonneville KR, Horton NJ, Micali N, et al. Longitudinal associations between
binge eating and overeating and adverse outcomes among adolescents and
young adults: does loss of control matter? JAMA Pediatr 2013;167(2):149–55.
38. Field AE, Sonneville KR, Micali N, et al. Prospective association of common
eating disorders and adverse outcomes. Pediatrics 2012;130(2):e289–95.
39. Algars M, Huang L, Von Holle AF, et al. Binge eating and menstrual dysfunction.
J Psychosom Res 2014;76(1):19–22.
40. Linna MS, Raevuori A, Haukka J, et al. Pregnancy, obstetric, and perinatal health
outcomes in eating disorders. Am J Obstet Gynecol 2014;211(4):392.e1-8.
41. Reichborn-Kjennerud T, Bulik CM, Sullivan PF, et al. Psychiatric and medical
symptoms in binge eating in the absence of compensatory behaviors. Obes
Res 2004;12(9):1445–54.
42. Johnson JG, Spitzer RL, Williams JB. Health problems, impairment and illnesses
associated with bulimia nervosa and binge eating disorder among primary care
and obstetric gynaecology patients. Psychol Med 2001;31(8):1455–66.
43. Kenardy J, Mensch M, Bowen K, et al. A comparison of eating behaviors in newly
diagnosed NIDDM patients and case-matched control subjects. Diabetes Care
1994;17(10):1197–9.
44. Takii M, Komaki G, Uchigata Y, et al. Differences between bulimia nervosa and
binge-eating disorder in females with type 1 diabetes: the important role of insulin
omission. J Psychosom Res 1999;47(3):221–31.
45. Hollinrake E, Abreu A, Maifeld M, et al. Increased risk of depressive disorders in
women with polycystic ovary syndrome. Fertil Steril 2007;87(6):1369–76.
46. Barnes RD, Boeka AG, McKenzie KC, et al. Metabolic syndrome in obese pa-
tients with binge-eating disorder in primary care clinics: a cross-sectional study.
Prim Care Companion CNS Disord 2011;13(2):PCC.10m01050.
47. Udo T, McKee SA, White MA, et al. Menopause and metabolic syndrome in obese
individuals with binge eating disorder. Eat Behav 2014;15(2):182–5.
48. Blomquist KK, Milsom VA, Barnes RD, et al. Metabolic syndrome in obese men
and women with binge eating disorder: developmental trajectories of eating
and weight-related behaviors. Compr Psychiatry 2012;53(7):1021–7.
12 Guerdjikova et al

49. Crow SJ, Peterson CB, Levine AS, et al. A survey of binge eating and obesity
treatment practices among primary care providers. Int J Eat Disord 2004;35(3):
348–53.
50. Mond JM, Myers TC, Crosby RD, et al. Bulimic eating disorders in primary care:
hidden morbidity still? J Clin Psychol Med Settings. 2010;17(1):56–63.
51. Gormally J, Black S, Daston S, et al. The assessment of binge eating severity
among obese persons. Addict Behav 1982;7(1):47–55.
52. Fairburn CG, Beglin SJ. Assessment of eating disorders: interview or self-report
questionnaire? Int J Eat Disord 1994;16(4):363–70.
53. Vocks S, Tuschen-Caffier B, Pietrowsky R, et al. Meta-analysis of the effectiveness
of psychological and pharmacological treatments for binge eating disorder. Int J
Eat Disord 2010;43(3):205–17.
54. Berkman ND, Brownley KA, Peat CM, et al. Management and outcomes of binge-
eating disorder. Rockville (MD): Agency for Healthcare Research and Quality;
2015.
55. McElroy SL, Guerdjikova AI, Mori N, et al. Overview of the treatment of binge
eating disorder. CNS Spectr 2015;20(6):546–56.
56. Fairburn CG, Rothwell ER. Apps and eating disorders: a systematic clinical
appraisal. Int J Eat Disord 2015;48(7):1038–46.
57. Mitchell JE, King WC, Courcoulas A, et al. Eating behavior and eating disorders in
adults before bariatric surgery. Int J Eat Disord 2015;48(2):215–22.
58. Mazzeo SE, Saunders R, Mitchell KS. Gender and binge eating among bariatric
surgery candidates. Eat Behav 2006;7(1):47–52.
59. Kennedy-Dalby A, Adam S, Ammori BJ, et al. Weight loss and metabolic out-
comes of bariatric surgery in men versus women - a matched comparative obser-
vational cohort study. Eur J Intern Med 2014;25(10):922–5.
60. Bulik CM, Sullivan PF, Kendler KS. Medical and psychiatric morbidity in obese
women with and without binge eating. Int J Eat Disord 2002;32(1):72–8.
61. Trace SE, Thornton LM, Runfola CD, et al. Sleep problems are associated with
binge eating in women. Int J Eat Disord 2012;45(5):695–703.
62. Rosenbaum DL, Kimerling R, Pomernacki A, et al. Binge eating among women
veterans in primary care: comorbidities and treatment priorities. Womens Health
Issues 2016;26(4):420–8.