Eating Disorders in Obesity: Beyond (and Behind) DSM Categories

Abstract

The DSM-IV classification of eating disorders introduced the new category of Binge Eating Disorder (BED), characterized by recurrent eating binges, which can be associated with overweight and obesity. Obese patients with BED, who are only a fraction of all obese individuals, show a higher mean degree of overweight, a greater comorbidity with medical conditions and mental disorders, and a greater impairment of health-related quality of life. Depressive symptoms are common among patients with BED, who could have a less favourable response to standard weight-reducing treatments. However, antidepressant drugs appear to have little effect in these patients, while psychotherapy (cognitive-behaviour therapy in particular) is effective for reducing frequency of eating binges, but not for weight control. Attempts at defining a neuroendocrine, genetic or metabolic base for BED have been, so far, rather inconclusive. Many authors question the clinical utility of the nosographic category of BED; in fact, episodic binge eating is characterized by psychopathological features similar to those of BED, even when established diagnostic thresholds of frequency of binges are not reached. Furthermore, other patterns of disturbed eating behaviour in obese patients could share some common characteristics with typical eating binges. Further research is needed to explore the complex pattern of eating disturbances in obesity, possibly using a dimensional, rather than a categorical, approach.